Doctor Name: | LETICIA MARIANA GONZALEZ |
NPI Number: | 1003209933 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | F.N.P. |
License Number: | 95002251 |
Business Practice Address: | 16 Ritter St San Rafael, CA - 949013323 |
Business Phone Number: | 4154578182 |
Business Fax Number: | 4154573490 |
Mailing Address: | 16 Ritter St, SAN RAFAEL |
State: | CA |
Postal Code: | 949013323 |
Phone Number: | 4154578182 |
Fax Number: | 4154573490 |
NPI Enumeration Date: | 03/17/2015 |
NPI Last Update Date: | 03/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 95002251 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |