Provider Demographics
NPI:1427839208
Name:M CECILIA GONZALEZ DDS A PROF CORP
Entity type:Organization
Organization Name:M CECILIA GONZALEZ DDS A PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-970-7934
Mailing Address - Street 1:15952 PERRIS BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-1320
Mailing Address - Country:US
Mailing Address - Phone:951-243-0282
Mailing Address - Fax:951-243-1457
Practice Address - Street 1:15952 PERRIS BLVD STE E
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-1320
Practice Address - Country:US
Practice Address - Phone:951-243-0282
Practice Address - Fax:951-243-1457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty