Healthcare Provider Details

I. General information

NPI: 1093314601
Provider Name (Legal Business Name): GLORIA AIMEE GONZALEZ CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GLORIA AIMEE LEYVA GONZALEZ CNM

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 JOHN JONES RD
DAVIS CA
95616-9701
US

IV. Provider business mailing address

1820 E GUM AVE
WOODLAND CA
95776-9390
US

V. Phone/Fax

Practice location:
  • Phone: 530-758-2060
  • Fax: 530-758-8490
Mailing address:
  • Phone: 530-219-6614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236136
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: