Healthcare Provider Details

I. General information

NPI: 1275026585
Provider Name (Legal Business Name): YESENIA GONZALEZ RN/FNP/MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YESENIA SANTA GONZALEZ

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 ABBY STREET
FRESNO CA
93701
US

IV. Provider business mailing address

311 ABBY STREET
FRESNO CA
93701-1906
US

V. Phone/Fax

Practice location:
  • Phone: 559-580-8088
  • Fax:
Mailing address:
  • Phone: 559-580-8088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95010450
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010450
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: