Provider Demographics
NPI:1235966136
Name:GONZALEZ, MICHAEL IVAN
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:IVAN
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1664 N VIRGINIA ST UNIVERSITY OF NEVADA RENO/0146
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89557-0146
Mailing Address - Country:US
Mailing Address - Phone:775-682-6752
Mailing Address - Fax:
Practice Address - Street 1:1664 N VIRGINIA ST UNIVERSITY OF NEVADA RENO/0146
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89557-0146
Practice Address - Country:US
Practice Address - Phone:775-682-6752
Practice Address - Fax:775-784-1814
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator