Basic Information
| Provider Information | |||||||||
| NPI: | 1831284348 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FELICIA GONZALEZ, DO, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 212 COMMONS WAY | ||||||||
| Address2: | BLDG. B | ||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322400244 | ||||||||
| FaxNumber: | 7322400644 | ||||||||
| Practice Location | |||||||||
| Address1: | 212 COMMONS WAY | ||||||||
| Address2: | BLDG. B | ||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322400244 | ||||||||
| FaxNumber: | 7322400644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 07/26/2007 | ||||||||
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| AuthorizedOfficialLastName: | GONZLAEZ | ||||||||
| AuthorizedOfficialFirstName: | FELICIA | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7322400244 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MB06259300 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.