Provider Demographics
NPI:1376027763
Name:GONZALEZ, VICTORIA LYNN (BCD, BPE)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:LYNN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:BCD, BPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20734 ICEFALL DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8861
Mailing Address - Country:US
Mailing Address - Phone:907-952-4443
Mailing Address - Fax:
Practice Address - Street 1:20734 ICEFALL DR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8861
Practice Address - Country:US
Practice Address - Phone:907-952-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty