Healthcare Provider Details

I. General information

NPI: 1487773222
Provider Name (Legal Business Name): ELIDA GONZALEZ N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 N ACACIA AVE
REEDLEY CA
93654
US

IV. Provider business mailing address

PO BOX 28949
FRESNO CA
93729-8949
US

V. Phone/Fax

Practice location:
  • Phone: 559-638-6027
  • Fax: 559-638-7196
Mailing address:
  • Phone: 559-228-4200
  • Fax: 559-224-3920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP4051
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: