Provider Demographics
NPI:1467201475
Name:GONZALEZ, CHRIS (CBD/CPD)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:CBD/CPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 LOMBARDY BLVD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-4029
Mailing Address - Country:US
Mailing Address - Phone:631-838-8332
Mailing Address - Fax:
Practice Address - Street 1:1350 LOMBARDY BLVD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-4029
Practice Address - Country:US
Practice Address - Phone:631-838-8332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula