Provider Demographics
NPI:1982251369
Name:GONZALEZ, CHANPHANY CHARLENE
Entity Type:Individual
Prefix:
First Name:CHANPHANY
Middle Name:CHARLENE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:CHANPHANY
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CHARLENE GONZALEZ
Mailing Address - Street 1:3741 N FELAND AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-4522
Mailing Address - Country:US
Mailing Address - Phone:559-347-8099
Mailing Address - Fax:
Practice Address - Street 1:3741 N FELAND AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-4522
Practice Address - Country:US
Practice Address - Phone:559-347-8099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA286912164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse