Provider Demographics
NPI:1861853996
Name:GOSAL, FEBRICIA
Entity Type:Individual
Prefix:
First Name:FEBRICIA
Middle Name:
Last Name:GOSAL
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 1:300 W 2ND ST APT 291
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-5281
Mailing Address - Country:US
Mailing Address - Phone:909-658-5514
Mailing Address - Fax:
Practice Address - Street 1:300 W 2ND ST APT 291
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5281
Practice Address - Country:US
Practice Address - Phone:909-658-5514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA246443164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse