Provider Demographics
NPI:1952982548
Name:GONZALEZ, GIOVANNI (CNA)
Entity Type:Individual
Prefix:
First Name:GIOVANNI
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3823 ROSSBERG ST SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-3590
Mailing Address - Country:US
Mailing Address - Phone:253-304-6202
Mailing Address - Fax:
Practice Address - Street 1:3823 ROSSBERG ST SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-3590
Practice Address - Country:US
Practice Address - Phone:253-304-6202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA754926311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home