Provider Demographics
NPI:1588913206
Name:DIEZ GONZALEZ, YARIGTNETZILEM (OD)
Entity type:Individual
Prefix:
First Name:YARIGTNETZILEM
Middle Name:
Last Name:DIEZ GONZALEZ
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19270 HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-5414
Mailing Address - Country:US
Mailing Address - Phone:707-939-6070
Mailing Address - Fax:
Practice Address - Street 1:19270 HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-5414
Practice Address - Country:US
Practice Address - Phone:707-939-6070
Practice Address - Fax:707-939-6078
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14449 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist