Provider Demographics
NPI:1780337121
Name:GONZALES, MARIO (DC)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:GONZALES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 E ALISAL ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3518
Mailing Address - Country:US
Mailing Address - Phone:831-424-4537
Mailing Address - Fax:
Practice Address - Street 1:123 E ALISAL ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3518
Practice Address - Country:US
Practice Address - Phone:831-424-4537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC33850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor