Provider Demographics
NPI:1962452888
Name:GONZALEZ, ZENITH AUSTEN (NP)
Entity Type:Individual
Prefix:
First Name:ZENITH
Middle Name:AUSTEN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ZENITH
Other - Middle Name:AUSTEN
Other - Last Name:LOBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3105 CEDAR RAVINE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6561
Mailing Address - Country:US
Mailing Address - Phone:530-295-1900
Mailing Address - Fax:530-295-9400
Practice Address - Street 1:3105 CEDAR RAVINE RD STE 103
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6561
Practice Address - Country:US
Practice Address - Phone:530-295-1900
Practice Address - Fax:530-295-9400
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12202363LX0001X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY49032YMedicaid
CAYYY49032YMedicaid
P47165Medicare UPIN