Provider Demographics
NPI:1588192512
Name:GONZALEZ, CRISTINA ANA (LPN)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:ANA
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 1:76 SPLIT CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-1615
Mailing Address - Country:US
Mailing Address - Phone:631-697-6532
Mailing Address - Fax:
Practice Address - Street 1:76 SPLIT CEDAR DR
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1615
Practice Address - Country:US
Practice Address - Phone:631-697-6532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325517-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse