Provider Demographics
NPI:1881234672
Name:GONZALEZ, HILDA A (DACM)
Entity type:Individual
Prefix:DR
First Name:HILDA
Middle Name:A
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11772 WESTVIEW PKWY APT 50
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-5586
Mailing Address - Country:US
Mailing Address - Phone:323-804-4269
Mailing Address - Fax:
Practice Address - Street 1:2555 STATE ST UNIT 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1315
Practice Address - Country:US
Practice Address - Phone:619-933-2340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74548225700000X
CA18473171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty