Provider Demographics
NPI:1942934518
Name:GONZAGA, CATHLEEN (MSN, RN, FNP)
Entity Type:Individual
Prefix:MS
First Name:CATHLEEN
Middle Name:
Last Name:GONZAGA
Suffix:
Gender:F
Credentials:MSN, RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 W ARROW RTE APT 79
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-7614
Mailing Address - Country:US
Mailing Address - Phone:626-257-4123
Mailing Address - Fax:
Practice Address - Street 1:1724 W ARROW RTE APT 79
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-7614
Practice Address - Country:US
Practice Address - Phone:626-257-4123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021298363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily