Provider Demographics
NPI:1932751443
Name:GONZALEZ, SAID M (MPH, RDN)
Entity type:Individual
Prefix:
First Name:SAID
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MPH, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45386 VIA NUBES
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4909
Mailing Address - Country:US
Mailing Address - Phone:951-760-1489
Mailing Address - Fax:
Practice Address - Street 1:45386 VIA NUBES
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-4909
Practice Address - Country:US
Practice Address - Phone:951-760-1489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86038429133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered