Provider Demographics
NPI:1568088300
Name:GONZALES, LORRAINE NICOLE CANADA (DNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:LORRAINE NICOLE
Middle Name:CANADA
Last Name:GONZALES
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8311 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3928
Mailing Address - Country:US
Mailing Address - Phone:562-923-4911
Mailing Address - Fax:
Practice Address - Street 1:8311 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3928
Practice Address - Country:US
Practice Address - Phone:562-923-4911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA95020419363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program