Provider Demographics
NPI:1750971743
Name:ASSO-GONZALEZ, OLIVIA E
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:E
Last Name:ASSO-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 1:62 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:CONESTOGA
Mailing Address - State:PA
Mailing Address - Zip Code:17516-9725
Mailing Address - Country:US
Mailing Address - Phone:717-553-3791
Mailing Address - Fax:
Practice Address - Street 1:62 W ELM ST
Practice Address - Street 2:
Practice Address - City:CONESTOGA
Practice Address - State:PA
Practice Address - Zip Code:17516-9725
Practice Address - Country:US
Practice Address - Phone:717-553-3791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer