Provider Demographics
NPI:1942921077
Name:CARLOS-GONZALEZ, ANAHI
Entity Type:Individual
Prefix:MS
First Name:ANAHI
Middle Name:
Last Name:CARLOS-GONZALEZ
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 1:3218 VALLEY FORGE DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-2131
Mailing Address - Country:US
Mailing Address - Phone:925-565-5230
Mailing Address - Fax:
Practice Address - Street 1:1803 W MARCH LN STE C&D
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6458
Practice Address - Country:US
Practice Address - Phone:925-565-5230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No172V00000XOther Service ProvidersCommunity Health Worker