Healthcare Provider Details

I. General information

NPI: 1780216549
Provider Name (Legal Business Name): NICOLE GONZALEZ NAVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 HOWARD ST
SAN FRANCISCO CA
94103-4114
US

IV. Provider business mailing address

1035 MARKET ST STE 400
SAN FRANCISCO CA
94103-1665
US

V. Phone/Fax

Practice location:
  • Phone: 415-487-3032
  • Fax:
Mailing address:
  • Phone: 415-487-3032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: