Individual
EDSON LUCERO GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4590 ALLSTATE DR, RIVERSIDE, CA 92501-1702
(909) 599-1227
Mailing address
4590 ALLSTATE DR, RIVERSIDE, CA 92501-1702
(909) 599-1227
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
06/07/2019
Last updated
05/31/2024
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