Provider Demographics
NPI:1063609196
Name:GRISEL GONZALEZ-DIAZ INC
Entity type:Organization
Organization Name:GRISEL GONZALEZ-DIAZ INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRISEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ-DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-785-4200
Mailing Address - Street 1:7201 ARLINGTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-1518
Mailing Address - Country:US
Mailing Address - Phone:951-785-4200
Mailing Address - Fax:
Practice Address - Street 1:7201 ARLINGTON AVE STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-1518
Practice Address - Country:US
Practice Address - Phone:951-785-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93596-01OtherDENTI-CAL