Provider Demographics
NPI:1689266470
Name:GONZALEZ, JUSTINE (RN)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9525 SORENSEN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-2650
Mailing Address - Country:US
Mailing Address - Phone:909-912-5619
Mailing Address - Fax:
Practice Address - Street 1:9525 SORENSEN AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-2650
Practice Address - Country:US
Practice Address - Phone:909-912-5619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA763904163WE0003X, 163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WE0003XNursing Service ProvidersRegistered NurseEmergency