Provider Demographics
NPI:1720764285
Name:GONZALEZ, CHRISTINE ALEXANDRIA
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ALEXANDRIA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12646 OAKBROOK CT
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-1522
Mailing Address - Country:US
Mailing Address - Phone:858-205-9026
Mailing Address - Fax:
Practice Address - Street 1:12646 OAKBROOK CT
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-1522
Practice Address - Country:US
Practice Address - Phone:858-205-9026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant