Provider Demographics
NPI:1417239138
Name:GONZALES, KRISTEN CATALANOTTO
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:CATALANOTTO
Last Name:GONZALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 HIGHWAY 59
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-1936
Mailing Address - Country:US
Mailing Address - Phone:985-626-0234
Mailing Address - Fax:985-626-0227
Practice Address - Street 1:2803 HIGHWAY 59
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-1936
Practice Address - Country:US
Practice Address - Phone:985-626-0234
Practice Address - Fax:985-626-0227
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist