Healthcare Provider Details

I. General information

NPI: 1528941424
Provider Name (Legal Business Name): ARIEL ALEXANDER GONZALEZ NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 08/18/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5887 BROCKTON AVE
RIVERSIDE CA
92506-1853
US

IV. Provider business mailing address

6207 BRIGHT AVE APT B
WHITTIER CA
90601-3621
US

V. Phone/Fax

Practice location:
  • Phone: 951-275-8500
  • Fax:
Mailing address:
  • Phone: 562-381-3519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95035566
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: