Provider Demographics
NPI:1528106333
Name:GONZALES, BEVERLY PIZARRO (DDS)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:PIZARRO
Last Name:GONZALES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13822 SAN ANTONIO DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4033
Mailing Address - Country:US
Mailing Address - Phone:562-868-6718
Mailing Address - Fax:562-864-5694
Practice Address - Street 1:13822 SAN ANTONIO DR
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4033
Practice Address - Country:US
Practice Address - Phone:562-868-6718
Practice Address - Fax:562-864-5694
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46187122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist