Provider Demographics
NPI:1194109702
Name:GONZALES, KELLY D (DNP)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:D
Last Name:GONZALES
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Gender:F
Credentials:DNP
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Mailing Address - Street 1:4282 GENESEE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4961
Mailing Address - Country:US
Mailing Address - Phone:858-292-0108
Mailing Address - Fax:858-292-9097
Practice Address - Street 1:4282 GENESEE AVE STE 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117
Practice Address - Country:US
Practice Address - Phone:858-292-0108
Practice Address - Fax:858-292-9097
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2018-06-12
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Provider Licenses
StateLicense IDTaxonomies
CA95002691363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics