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General NPI Number Information
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NPI Number | 1881589539
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Entity Type | Individual
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Provider Name | SAM ROBERT GONZALES CNA
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Gender | Male
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 159 BRENTWOOD DR
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City | GRASS VALLEY
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State | CA
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Zip | 95945-5703
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Country | US
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Telephone | 530-460-4082
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Fax | 530-273-9541
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Provider Business Mailing Address
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Address Line | 159 BRENTWOOD DR
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City | GRASS VALLEY
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State | CA
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Zip | 95945-5703
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Country | US
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Telephone | 530-460-4082
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Fax | 530-273-5410
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 01224031
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License Number State | CA
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