Provider Demographics
NPI:1053558882
Name:GONZALEZ, SANDRA CORONA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:CORONA
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 1:44558 10TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3333
Mailing Address - Country:US
Mailing Address - Phone:661-723-1111
Mailing Address - Fax:661-726-0587
Practice Address - Street 1:508 W IVESBROOK AVE APT 117
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2592
Practice Address - Country:US
Practice Address - Phone:661-945-7736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71964126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant