Healthcare Provider Details

I. General information

NPI: 1831634971
Provider Name (Legal Business Name): LUCIA GONZALES PHD, RN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2016
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 CAMINO DE LA SIESTA #106
SAN DIEGO CA
92108-3116
US

IV. Provider business mailing address

12075 SABRE SPRINGS PKWY APT 408
SAN DIEGO CA
92128-6606
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-4401
  • Fax: 619-692-8147
Mailing address:
  • Phone: 760-690-7241
  • Fax: 619-692-8147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95001784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: