Healthcare Provider Details

I. General information

NPI: 1831723519
Provider Name (Legal Business Name): PATRINELLA GONZALES CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81833 DR CARREON BLVD STE 6
INDIO CA
92201-5590
US

IV. Provider business mailing address

23500 SCOOTER WAY
MURRIETA CA
92562-6312
US

V. Phone/Fax

Practice location:
  • Phone: 760-775-7763
  • Fax:
Mailing address:
  • Phone: 951-206-4150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95012734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: