Provider Demographics
NPI:1336901883
Name:GONZALES, ALYSSA JOANA
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JOANA
Last Name:GONZALES
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 1:750 FONT BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1731
Mailing Address - Country:US
Mailing Address - Phone:209-431-7834
Mailing Address - Fax:
Practice Address - Street 1:750 FONT BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1731
Practice Address - Country:US
Practice Address - Phone:209-431-7834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker