Healthcare Provider Details

I. General information

NPI: 1992094635
Provider Name (Legal Business Name): NANCY GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 S BRAND BLVD
SAN FERNANDO CA
91340-4002
US

IV. Provider business mailing address

566 S BRAND BLVD
SAN FERNANDO CA
91340-4002
US

V. Phone/Fax

Practice location:
  • Phone: 818-898-0223
  • Fax: 818-361-5384
Mailing address:
  • Phone: 818-898-0223
  • Fax: 818-361-5384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: