Healthcare Provider Details

I. General information

NPI: 1992676290
Provider Name (Legal Business Name): KYLE ANTHONY GONZALES DNP, PMHNP-BC, RN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 CORINTH AVE STE 309
LOS ANGELES CA
90064-1622
US

IV. Provider business mailing address

2211 CORINTH AVE STE 309
LOS ANGELES CA
90064-1622
US

V. Phone/Fax

Practice location:
  • Phone: 909-684-5377
  • Fax: 951-338-7171
Mailing address:
  • Phone: 909-684-5377
  • Fax: 951-338-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95035972
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: