Healthcare Provider Details

I. General information

NPI: 1912931528
Provider Name (Legal Business Name): DORAL RENEE GONZALES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DORAL RENEE GONZALES FNP

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 SUNSET DR BUILDING # 3
HOLLISTER CA
95023-5780
US

IV. Provider business mailing address

1709 VIA MILANO
GUSTINE CA
95322-9682
US

V. Phone/Fax

Practice location:
  • Phone: 831-636-2664
  • Fax: 831-636-2641
Mailing address:
  • Phone: 408-348-1894
  • Fax: 209-854-6805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN 348323
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP 13815
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP1700X
TaxonomyPerinatal Nurse Practitioner
License NumberNM 1248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: