MEDICARE: MAYETTE BAYLON GONZALES NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95025044	CA

General Provider Information

NPI Number	:	1154006310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYETTE BAYLON GONZALES NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3988 MERRILL AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-2214
Country	:	US
Telephone Number	:	909-304-3344
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2023
Last Update Date	:	06/02/2026

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