Healthcare Provider Details

I. General information

NPI: 1902505167
Provider Name (Legal Business Name): CHRISTINA LYNN GONZALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47825 OASIS ST
INDIO CA
92201-6950
US

IV. Provider business mailing address

30870 AVENIDA DEL YERMO
CATHEDRAL CITY CA
92234-4900
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-8441
  • Fax:
Mailing address:
  • Phone: 760-578-7187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-OYUZEX
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: