Provider Demographics
NPI:1205486131
Name:GONZALES, JOCELYN SISTOSO (NP-C, FNP-BC)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:SISTOSO
Last Name:GONZALES
Suffix:
Gender:F
Credentials:NP-C, FNP-BC
Other - Prefix:
Other - First Name:JOCELYN
Other - Middle Name:PINOY
Other - Last Name:SISTOSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 S ST ANDREWS PL APT 6
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-5789
Mailing Address - Country:US
Mailing Address - Phone:310-666-8385
Mailing Address - Fax:
Practice Address - Street 1:109 S ST ANDREWS PL APT 6
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-5789
Practice Address - Country:US
Practice Address - Phone:310-666-8385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA630454163W00000X
CA95012625363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse