Individual
VILMA TERESA GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
627 W FRANKLIN ST, SHELTON, WA 98584-3504
(360) 763-5610
Mailing address
PO BOX 1965, SHELTON, WA 98584-5030
(360) 890-8239
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CG61038464
—
WA
Enumeration date
01/22/2020
Last updated
01/22/2020
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