Healthcare Provider Details

I. General information

NPI: 1578318283
Provider Name (Legal Business Name): KRISTI MARES LLOREN GONZALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 TERRACINA BLVD
REDLANDS CA
92373-4847
US

IV. Provider business mailing address

295 TERRACINA BLVD
REDLANDS CA
92373-4847
US

V. Phone/Fax

Practice location:
  • Phone: 909-253-1450
  • Fax: 909-277-6816
Mailing address:
  • Phone: 909-253-1450
  • Fax: 909-277-6816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95028021
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: