Provider Demographics
NPI:1003110578
Name:GONZALEZ, MELISSA VICTORIA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:VICTORIA
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 1:307 ORANGE AVE APT 82
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-4171
Mailing Address - Country:US
Mailing Address - Phone:619-952-6340
Mailing Address - Fax:
Practice Address - Street 1:307 ORANGE AVE APT 82
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-4171
Practice Address - Country:US
Practice Address - Phone:619-952-6340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide