Provider Demographics
NPI:1487923140
Name:GONZALES, RANDA H (DO)
Entity type:Individual
Prefix:MS
First Name:RANDA
Middle Name:H
Last Name:GONZALES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RANDA
Other - Middle Name:H
Other - Last Name:CHDID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200A 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3904
Mailing Address - Country:US
Mailing Address - Phone:650-685-8828
Mailing Address - Fax:650-685-0101
Practice Address - Street 1:200A 2ND AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3904
Practice Address - Country:US
Practice Address - Phone:650-685-8828
Practice Address - Fax:650-685-0101
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19049156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician