Healthcare Provider Details

I. General information

NPI: 1922751072
Provider Name (Legal Business Name): ARNA ALYSSA GONZALES GUMANGAN BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2022
Last Update Date: 01/29/2022
Certification Date: 01/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HUNTER LN
CAMP HILL PA
17011-2400
US

IV. Provider business mailing address

26321 MARGARITA LN
LOMA LINDA CA
92354-6737
US

V. Phone/Fax

Practice location:
  • Phone: 800-748-3243
  • Fax:
Mailing address:
  • Phone: 909-203-2774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95264517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: