Healthcare Provider Details

I. General information

NPI: 1770710063
Provider Name (Legal Business Name): EVA GONZALEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 1ST AVE
NEW YORK NY
10029-7404
US

IV. Provider business mailing address

1901 1ST AVE
NEW YORK NY
10029-7404
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6585
  • Fax: 212-423-8177
Mailing address:
  • Phone: 212-423-6585
  • Fax: 212-423-8177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number369570-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: