Provider Demographics
NPI:1952981649
Name:GONZALEZ, ALEXIS
Entity Type:Individual
Prefix:MR
First Name:ALEXIS
Middle Name:
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 1:101 TACOMA BLVD N APT 3
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:WA
Mailing Address - Zip Code:98047-1045
Mailing Address - Country:US
Mailing Address - Phone:253-221-4214
Mailing Address - Fax:855-707-0303
Practice Address - Street 1:101 TACOMA BLVD N APT 3
Practice Address - Street 2:
Practice Address - City:PACIFIC
Practice Address - State:WA
Practice Address - Zip Code:98047-1045
Practice Address - Country:US
Practice Address - Phone:253-221-4214
Practice Address - Fax:855-707-0303
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC18872171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter