Provider Demographics
NPI:1457337255
Name:NINONUEVO, FRED GONZALES (PHD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:GONZALES
Last Name:NINONUEVO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:585 LANDS END WAY
Mailing Address - Street 2:UNIT 233
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-7287
Mailing Address - Country:US
Mailing Address - Phone:760-231-8679
Mailing Address - Fax:760-231-8679
Practice Address - Street 1:NAVAL HOSPITAL CAMP PENDLETON
Practice Address - Street 2:BLDG H100 ATTN: CODE 094
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5191
Practice Address - Country:US
Practice Address - Phone:760-725-1555
Practice Address - Fax:760-725-1350
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNLP 1987103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical