Provider Demographics
NPI:1063881571
Name:GONZALES, RAQUEL
Entity type:Individual
Prefix:MISS
First Name:RAQUEL
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 BALHAN DR APT 204
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-3778
Mailing Address - Country:US
Mailing Address - Phone:503-269-8894
Mailing Address - Fax:
Practice Address - Street 1:1333 WILLOW PASS RD STE 102
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5225
Practice Address - Country:US
Practice Address - Phone:925-825-1793
Practice Address - Fax:925-825-7094
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program