Provider Demographics
NPI:1528665312
Name:GONZALEZ, MARIELA R
Entity type:Individual
Prefix:
First Name:MARIELA
Middle Name:R
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:WRIGHT INSTITUTE CLINICAL SERVICES
Mailing Address - Street 2:1918 UNIVERSITY AVENUE SUITE 2B
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704
Mailing Address - Country:US
Mailing Address - Phone:510-548-9716
Mailing Address - Fax:
Practice Address - Street 1:WRIGHT INSTITUTE CLINICAL SERVICES
Practice Address - Street 2:1918 UNIVERSITY AVENUE SUITE 2B
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704
Practice Address - Country:US
Practice Address - Phone:510-548-9716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program