Provider Demographics
NPI:1588984066
Name:GONZALEZ, MARA NONITA SERRANO
Entity type:Individual
Prefix:
First Name:MARA NONITA
Middle Name:SERRANO
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 STERLING OAKS DR
Mailing Address - Street 2:APARTMENT 145
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-9451
Mailing Address - Country:US
Mailing Address - Phone:530-413-3016
Mailing Address - Fax:
Practice Address - Street 1:2700 ORO DAM BLVD E
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-5117
Practice Address - Country:US
Practice Address - Phone:530-533-8773
Practice Address - Fax:530-533-8627
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist