Individual
JULIE ELENY GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
707 SW 10TH ST APT 406, CORVALLIS, OR 97333-4578
(909) 851-4181
Mailing address
707 SW 10TH ST APT 406, CORVALLIS, OR 97333-4578
(909) 851-4181
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
379
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2008837905
PACIFIC SOURCE
OR
Enumeration date
06/21/2021
Last updated
06/21/2021
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