Provider Demographics
NPI:1851026710
Name:HOSENA, DESIREE ANN GONZALES
Entity Type:Individual
Prefix:
First Name:DESIREE ANN GONZALES
Middle Name:
Last Name:HOSENA
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 1:5213 WINDERMERE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1140
Mailing Address - Country:US
Mailing Address - Phone:323-823-4969
Mailing Address - Fax:
Practice Address - Street 1:5213 WINDERMERE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1140
Practice Address - Country:US
Practice Address - Phone:323-823-4969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered