Provider Demographics
NPI:1649988312
Name:GONZALES, CASILDA ROMERO (RN PHN)
Entity type:Individual
Prefix:
First Name:CASILDA
Middle Name:ROMERO
Last Name:GONZALES
Suffix:
Gender:F
Credentials:RN PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 PINE CREEK WAY APT F
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-3633
Mailing Address - Country:US
Mailing Address - Phone:925-324-4829
Mailing Address - Fax:
Practice Address - Street 1:1250 PINE CREEK WAY APT F
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-3633
Practice Address - Country:US
Practice Address - Phone:925-324-4829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA430785163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse