Provider Demographics
NPI:1376910703
Name:GONZALEZ, HILDA (LPN)
Entity Type:Individual
Prefix:MS
First Name:HILDA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 E 172ND ST
Mailing Address - Street 2:APT 1F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-2262
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:391 E 149TH STREET, SUITE 405
Practice Address - Street 2:PCMH BRONX ACT PROGRAM
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455
Practice Address - Country:US
Practice Address - Phone:718-215-1117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228392164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse