Individual
GERARDO REYNAGA GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2168 LA MIRADA DR, EL SOBRANTE, CA 94803-3216
(510) 504-3005
Mailing address
1556 FITZGERALD DR # 116, PINOLE, CA 94564-2229
(510) 504-3005
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
876
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
876
PRIVATE
CA
Enumeration date
02/23/2022
Last updated
02/23/2022
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