Provider Demographics
NPI:1225419500
Name:GONZALES, ROBERTO (NP-C)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:GONZALES
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-1849
Mailing Address - Country:US
Mailing Address - Phone:419-626-5623
Mailing Address - Fax:419-626-4824
Practice Address - Street 1:420 SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-1849
Practice Address - Country:US
Practice Address - Phone:419-626-5623
Practice Address - Fax:419-626-4824
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRNCNP17452363LF0000X
OH17452-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily