Healthcare Provider Details

I. General information

NPI: 1750021705
Provider Name (Legal Business Name): ASHLEY LORRAINE GONZALEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1463 S 4TH ST
EL CENTRO CA
92243-4556
US

IV. Provider business mailing address

1812 BARBARA WAY
EL CENTRO CA
92243-6128
US

V. Phone/Fax

Practice location:
  • Phone: 619-881-4500
  • Fax:
Mailing address:
  • Phone: 760-235-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95059758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: