Provider Demographics
NPI:1912454299
Name:GONZALES, ERICA (RDHAP)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2543 EVELYN CT E
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-0201
Mailing Address - Country:US
Mailing Address - Phone:408-204-9071
Mailing Address - Fax:
Practice Address - Street 1:2543 EVELYN CT E
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-0201
Practice Address - Country:US
Practice Address - Phone:408-204-9071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-05
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA629124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist