Provider Demographics
NPI:1821972670
Name:GONZALEZ, ELIZABETH UBALDA DEL CARMEN (CMA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:UBALDA DEL CARMEN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:UBALDA
Other - Last Name:MENDOZA VASQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMA, MASTER DEGREE
Mailing Address - Street 1:28475 MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-1714
Mailing Address - Country:US
Mailing Address - Phone:619-359-7386
Mailing Address - Fax:
Practice Address - Street 1:1745 HOLLISTER ST UNIT 22
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-4531
Practice Address - Country:US
Practice Address - Phone:619-666-4451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No172V00000XOther Service ProvidersCommunity Health Worker