Provider Demographics
NPI:1922620657
Name:GONZALEZ, BETHANIA (FNP)
Entity type:Individual
Prefix:MRS
First Name:BETHANIA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BETHANIA
Other - Middle Name:GONZALEZ
Other - Last Name:MENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:415 E CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4517
Mailing Address - Country:US
Mailing Address - Phone:888-898-3806
Mailing Address - Fax:805-928-7671
Practice Address - Street 1:415 E CHAPEL ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4517
Practice Address - Country:US
Practice Address - Phone:888-898-3806
Practice Address - Fax:805-928-7671
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-15
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013977363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily