MEDICARE: LAURA ANN GONZALES

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
1	164X00000X	Licensed Vocational Nurse	VN223987	CA

General Provider Information

NPI Number	:	1972645927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ANN GONZALES

Provider Business Mailing Address
First Line	:	100 N BARRANCA ST # 130
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91791-1637
Country	:	US
Telephone Number	:	626-962-6061
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N BARRANCA ST # 130
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91791-1637
Country	:	US
Telephone Number	:	626-962-6061
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	01/14/2025

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