Provider Demographics
NPI:1487738001
Name:GONZALES, SHARON LEA (DC)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:LEA
Last Name:GONZALES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 TICATICA DR
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-5435
Mailing Address - Country:US
Mailing Address - Phone:626-330-0651
Mailing Address - Fax:
Practice Address - Street 1:1201 S HACIENDA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-2200
Practice Address - Country:US
Practice Address - Phone:626-330-0651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC013781111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor