Provider Demographics
NPI:1518720135
Name:GONZALEZ, LAURA NAYELI
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:NAYELI
Last Name:GONZALEZ
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 1:731 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-5210
Mailing Address - Country:US
Mailing Address - Phone:630-486-8322
Mailing Address - Fax:
Practice Address - Street 1:731 JACKSON ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-5210
Practice Address - Country:US
Practice Address - Phone:630-486-8322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILG52453490759343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)