Provider Demographics
NPI:1992943922
Name:GONZALEZ, ANA E
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:E
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 1:12730 HAWTHORNE BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-3919
Mailing Address - Country:US
Mailing Address - Phone:310-644-4000
Mailing Address - Fax:310-644-3232
Practice Address - Street 1:12730 HAWTHORNE BLVD STE D
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3919
Practice Address - Country:US
Practice Address - Phone:310-644-4000
Practice Address - Fax:310-644-3232
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4490725126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant