Provider Demographics
NPI:1235311036
Name:GONZALEZ, DANIEL (LAC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 BROAD ST APT 10
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-1844
Mailing Address - Country:US
Mailing Address - Phone:828-676-9693
Mailing Address - Fax:
Practice Address - Street 1:23 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2903
Practice Address - Country:US
Practice Address - Phone:828-424-7415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC328171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist