Provider Demographics
NPI:1255662037
Name:GONZALES, ALISHA PAULINE (LVN)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:PAULINE
Last Name:GONZALES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 S STOCKTON ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-1801
Mailing Address - Country:US
Mailing Address - Phone:209-607-4702
Mailing Address - Fax:
Practice Address - Street 1:2055 S STOCKTON ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-1801
Practice Address - Country:US
Practice Address - Phone:209-607-4702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240279164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse