Healthcare Provider Details

I. General information

NPI: 1104631068
Provider Name (Legal Business Name): KARINA GONZALEZ RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2506 MARKET ST
SAN DIEGO CA
92102-3010
US

IV. Provider business mailing address

1400 N JOHNSON AVE STE 101
EL CAJON CA
92020-1651
US

V. Phone/Fax

Practice location:
  • Phone: 619-294-5760
  • Fax:
Mailing address:
  • Phone: 619-442-0277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95401103
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: