Provider Demographics
NPI:1922368836
Name:GONZAGA, MA CRISTINA VALENCIA (APN-BC)
Entity Type:Individual
Prefix:
First Name:MA CRISTINA
Middle Name:VALENCIA
Last Name:GONZAGA
Suffix:
Gender:F
Credentials:APN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 JORALEMON ST UNIT 59
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1482
Mailing Address - Country:US
Mailing Address - Phone:862-215-7643
Mailing Address - Fax:
Practice Address - Street 1:725 JORALEMON ST UNIT 59
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1482
Practice Address - Country:US
Practice Address - Phone:862-215-7643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00379100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health