Provider Demographics
NPI:1801041546
Name:GONZALEZ, LUIS GUILLERMO
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:GUILLERMO
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5890 NEWMAN CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-2608
Mailing Address - Country:US
Mailing Address - Phone:916-452-7481
Mailing Address - Fax:916-732-0282
Practice Address - Street 1:5890 NEWMAN CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-2608
Practice Address - Country:US
Practice Address - Phone:916-452-7481
Practice Address - Fax:916-732-0282
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program