Provider Demographics
NPI:1346559317
Name:GONZALES, BERNADETTE PAMULO (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:BERNADETTE
Middle Name:PAMULO
Last Name:GONZALES
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 N. MOHLER DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92808
Mailing Address - Country:US
Mailing Address - Phone:714-998-7088
Mailing Address - Fax:
Practice Address - Street 1:197 N. MOHLER DRIVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM HILLS
Practice Address - State:CA
Practice Address - Zip Code:92808
Practice Address - Country:US
Practice Address - Phone:714-998-7088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 19702363L00000X
CAF1208164363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily