Provider Demographics
NPI:1275026585
Name:GONZALEZ, YESENIA (RN/FNP/MSN)
Entity Type:Individual
Prefix:
First Name:YESENIA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RN/FNP/MSN
Other - Prefix:
Other - First Name:YESENIA
Other - Middle Name:SANTA
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:311 ABBY STREET
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-1906
Mailing Address - Country:US
Mailing Address - Phone:559-580-8088
Mailing Address - Fax:
Practice Address - Street 1:311 ABBY STREET
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701
Practice Address - Country:US
Practice Address - Phone:559-580-8088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010450363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF08180936Medicaid