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Organization
GONZALES MEDICAL CORPORATION
Active
Organization
GONZALES MEDICAL CORPORATION
Active
Other names
Divine Grace Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY EPPIE PORCIUNCULA GONZALES MD (CEO)
(562) 474-1605
Entity
Organization
Contact information
Practice address
17150 NORWALK BLVD STE 104, CERRITOS, CA 90703-2751
(562) 303-6662
Mailing address
17150 NORWALK BLVD STE 104, CERRITOS, CA 90703-2751
(562) 474-1605
(562) 444-0456
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
11/22/2018
Last updated
06/01/2020
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