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NPI Code Detail

MEDICARE: SAMRAH MARISOL GONZALEZ

MEDICARE: SAMRAH MARISOL GONZALEZ
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 Nurse692429CA

General Provider Information

NPI Number : 1568237220
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMRAH MARISOL GONZALEZ
Provider Business Mailing Address
First Line : 161 LAURIE MEADOWS DR APT 568
Second Line :
City : SAN MATEO
State : CA
Zip : 94403-4839
Country : US
Telephone Number : 415-596-1332
Fax Number :
Provider Business Practice Location Address
First Line : 3037 BRYANT PL
Second Line :
City : DAVIS
State : CA
Zip : 95618-1613
Country : US
Telephone Number : 415-596-1332
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2023
Last Update Date : 11/21/2023

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Directions to “ SAMRAH MARISOL GONZALEZ ” Practice Location

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