Provider Demographics
NPI:1427853274
Name:GONZALES, KRISSY (BSN,NTP,RWP)
Entity type:Individual
Prefix:
First Name:KRISSY
Middle Name:
Last Name:GONZALES
Suffix:
Gender:
Credentials:BSN,NTP,RWP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35119 PERSANO PL
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-7703
Mailing Address - Country:US
Mailing Address - Phone:858-397-4058
Mailing Address - Fax:
Practice Address - Street 1:35119 PERSANO PL
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-7703
Practice Address - Country:US
Practice Address - Phone:858-397-4058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist