Provider Demographics
NPI:1760067888
Name:GONZALEZ, NADIA DEEANN
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:DEEANN
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 1:3749 N FRUIT AVE APT B
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-5233
Mailing Address - Country:US
Mailing Address - Phone:559-813-4047
Mailing Address - Fax:
Practice Address - Street 1:3749 N FRUIT AVE APT B
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-5233
Practice Address - Country:US
Practice Address - Phone:559-813-4047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01177840376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASSNOtherNADIA GONZALEZ