Provider Demographics
NPI:1003209933
Name:GONZALEZ, LETICIA MARIANA (FNP)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:MARIANA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-2412
Mailing Address - Country:US
Mailing Address - Phone:510-981-4100
Mailing Address - Fax:
Practice Address - Street 1:PLANNED PARENTHOOD EL CERRITO HEALTH CENTER
Practice Address - Street 2:320 EL CERRITO PLAZA
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530
Practice Address - Country:US
Practice Address - Phone:510-527-5806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002251363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily