Provider Demographics
NPI:1386279545
Name:GONZALEZ, VERONICA
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:GONZALEZ
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 1:16506 LAKEWOOD BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-5165
Mailing Address - Country:US
Mailing Address - Phone:562-867-5300
Mailing Address - Fax:562-678-6666
Practice Address - Street 1:16506 LAKEWOOD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-5165
Practice Address - Country:US
Practice Address - Phone:562-867-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0106XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular-Interventional Technology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA261967361Medicaid