Provider Demographics
NPI:1255645412
Name:GONZALES, EMIL F (LVN)
Entity type:Individual
Prefix:MR
First Name:EMIL
Middle Name:F
Last Name:GONZALES
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8237 BLUFFVIEW CT
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-6102
Mailing Address - Country:US
Mailing Address - Phone:619-578-3002
Mailing Address - Fax:
Practice Address - Street 1:8237 BLUFFVIEW CT
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-6102
Practice Address - Country:US
Practice Address - Phone:619-578-3002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN168489164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse