Provider Demographics
NPI:1912224718
Name:GONZALES, NANCY CHRISTINA
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:CHRISTINA
Last Name:GONZALES
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 1:1085 W VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-5804
Mailing Address - Country:US
Mailing Address - Phone:310-868-5379
Mailing Address - Fax:
Practice Address - Street 1:1085 W VICTORIA ST
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-5804
Practice Address - Country:US
Practice Address - Phone:310-868-5379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner