Individual
SHIRLEY GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
40 SPRING ST, WATERTOWN, MA 02472-3444
(617) 926-0114
(617) 926-7052
Mailing address
40 SPRING ST, WATERTOWN, MA 02472-3444
(617) 926-0114
(617) 926-7052
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
153812
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3201180
—
MA
Enumeration date
09/22/2005
Last updated
12/17/2013
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