Provider Demographics
NPI:1093314601
Name:GONZALEZ, GLORIA AIMEE (CNM)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:AIMEE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:AIMEE
Other - Last Name:LEYVA GONZALEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNM
Mailing Address - Street 1:1820 E GUM AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95776-9390
Mailing Address - Country:US
Mailing Address - Phone:530-219-6614
Mailing Address - Fax:
Practice Address - Street 1:2051 JOHN JONES RD
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-9701
Practice Address - Country:US
Practice Address - Phone:530-758-2060
Practice Address - Fax:530-758-8490
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236136367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife