Provider Demographics
NPI:1518470921
Name:GONZALEZ, CARLA IRIS (FNP-C)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:IRIS
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:IRIS
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:16465 SIERRA LAKES PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1242
Mailing Address - Country:US
Mailing Address - Phone:909-429-2864
Mailing Address - Fax:909-429-2868
Practice Address - Street 1:16465 SIERRA LAKES PKWY STE 300
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1242
Practice Address - Country:US
Practice Address - Phone:909-429-2864
Practice Address - Fax:909-429-2868
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF10170409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily