Provider Demographics
NPI:1164845087
Name:GONZALES, TRINIDAD (RN)
Entity Type:Individual
Prefix:MRS
First Name:TRINIDAD
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 S VALLEY VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-4361
Mailing Address - Country:US
Mailing Address - Phone:702-759-0859
Mailing Address - Fax:702-759-1455
Practice Address - Street 1:330 S VALLEY VIEW BLVD.
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147
Practice Address - Country:US
Practice Address - Phone:702-759-0859
Practice Address - Fax:702-759-1455
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV40611163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse