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NPI Code Detail

MEDICARE: MRS. LISA ELIZABETH GONZALES CNM

MEDICARE: MRS. LISA ELIZABETH GONZALES CNM
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
1176B00000XMidwife0024169804VA
2367A00000XAdvanced Practice Midwife0024169804VA
3367A00000XAdvanced Practice MidwifeNM236574CA

General Provider Information

NPI Number : 1275801425
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA ELIZABETH GONZALES CNM
Provider Business Mailing Address
First Line : PO BOX 255228
Second Line :
City : SACRAMENTO
State : CA
Zip : 95865-5228
Country : US
Telephone Number : 800-470-0071
Fax Number : 916-854-6769
Provider Business Practice Location Address
First Line : 2020 SUTTER PL STE 203
Second Line :
City : DAVIS
State : CA
Zip : 95616-6217
Country : US
Telephone Number : 530-750-5880
Fax Number : 530-750-5881
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2011
Last Update Date : 01/12/2026

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