Individual
LELA THERESE GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4805 NE GLISAN ST, STE BG05, PORTLAND, OR 97213-2933
(503) 215-2392
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD173266
OR
208M00000X
Hospitalist Physician
Primary
MD173266
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500693980
—
OR
01
—
P01547776
RR MEDICARE (PH&S)-PMG
OR
Enumeration date
05/28/2012
Last updated
01/18/2021
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