Basic Information
| Provider Information | |||||||||
| NPI: | 1285301077 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | NATALYA | ||||||||
| MiddleName: | GABRIELA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1260 MORENA BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921103850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6193983261 | ||||||||
| FaxNumber: | 6192752023 | ||||||||
| Practice Location | |||||||||
| Address1: | 1260 MORENA BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921103850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6193983261 | ||||||||
| FaxNumber: | 6192752023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2021 | ||||||||
| LastUpdateDate: | 11/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175T00000X | Y |
No ID Information.