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NPI Code Detail

MEDICARE: DESTINY NICOLE GONZALEZ LVN

MEDICARE: DESTINY NICOLE GONZALEZ LVN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164X00000XLicensed Vocational Nurse755919CA

General Provider Information

NPI Number : 1164373197
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESTINY NICOLE GONZALEZ LVN
Provider Business Mailing Address
First Line : 5190 ATLANTIC AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90805-6510
Country : US
Telephone Number : 562-428-4111
Fax Number :
Provider Business Practice Location Address
First Line : 5190 ATLANTIC AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90805-6510
Country : US
Telephone Number : 562-428-4111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2026
Last Update Date : 02/05/2026

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