Provider Demographics
NPI:1598867657
Name:GONZALEZ, AUDREY ARACELY (NP)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:ARACELY
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 N OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-1037
Mailing Address - Country:US
Mailing Address - Phone:714-779-8305
Mailing Address - Fax:
Practice Address - Street 1:947 S ANAHEIM BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5582
Practice Address - Country:US
Practice Address - Phone:714-635-4424
Practice Address - Fax:714-635-5704
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16161363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A337400OtherMEDI-CAL
CAGR0058410OtherMEDI-CAL