Provider Demographics
NPI:1932883634
Name:GONZALES, ARIS MARC ADEL (LVN)
Entity Type:Individual
Prefix:
First Name:ARIS MARC
Middle Name:ADEL
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 1:126 CROCKER AVE
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-1110
Mailing Address - Country:US
Mailing Address - Phone:415-828-6265
Mailing Address - Fax:
Practice Address - Street 1:126 CROCKER AVE
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-1110
Practice Address - Country:US
Practice Address - Phone:415-828-6265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA721283164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse