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General NPI Number Information
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NPI Number | 1235450495
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Entity Type | Individual
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Provider Name | MARY CHRISTINE DEASIS GONZALES MSN,FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/22/2010
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 11201 BENTON ST
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City | LOMA LINDA
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State | CA
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Zip | 92357-5527
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Country | US
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Telephone | 909-825-7084
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Fax |
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Provider Business Mailing Address
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Address Line | 11117 ALAMO RD
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City | LOMA LINDA
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State | CA
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Zip | 92354-6511
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Country | US
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Telephone | 323-234-5000
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Fax | 323-234-3900
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP19704
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License Number State | CA
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