Provider Demographics
NPI:1144773763
Name:GONZALEZ, AMANDA MARIE MITCHELL (ATC, EMT-P)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE MITCHELL
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:ATC, EMT-P
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:3643 BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-3805
Mailing Address - Country:US
Mailing Address - Phone:661-618-5305
Mailing Address - Fax:
Practice Address - Street 1:3643 BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-3805
Practice Address - Country:US
Practice Address - Phone:661-618-5305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-31
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer