Individual
EDNA M GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8865 W 400 N, #115, MICHIGAN CITY, IN 46360-9222
(219) 872-7268
(219) 872-2224
Mailing address
3120 MACON ST, PORTAGE, IN 46368-4522
(217) 872-7268
(219) 872-2224
Taxonomy
Speciality
Code
Description
License number
State
243U00000X
Radiology Practitioner Assistant
Primary
—
—
Other
Enumeration date
05/20/2011
Last updated
05/20/2011
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