Provider Demographics
NPI:1235450495
Name:GONZALES, MARY CHRISTINE DEASIS (MSN,FNP-C)
Entity Type:Individual
Prefix:
First Name:MARY CHRISTINE
Middle Name:DEASIS
Last Name:GONZALES
Suffix:
Gender:F
Credentials:MSN,FNP-C
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Mailing Address - Street 1:11117 ALAMO RD
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-6511
Mailing Address - Country:US
Mailing Address - Phone:323-234-5000
Mailing Address - Fax:323-234-3900
Practice Address - Street 1:2707 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-5527
Practice Address - Country:US
Practice Address - Phone:323-234-3900
Practice Address - Fax:323-234-3900
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2013-02-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CANP19704363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner