Provider Demographics
NPI:1306088646
Name:GATEWOOD, DENISE VALENCIA (RNP)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:VALENCIA
Last Name:GATEWOOD
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:VALENCIA
Other - Last Name:GATEWOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1830 E 215TH ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-1814
Mailing Address - Country:US
Mailing Address - Phone:310-493-3076
Mailing Address - Fax:
Practice Address - Street 1:12321 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250
Practice Address - Country:US
Practice Address - Phone:310-263-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13354363LX0001X
CA481901363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA481901OtherREGISTERED NURSE
CA13354OtherNURSE PRACTITIONER