Provider Demographics
NPI:1912931528
Name:GONZALES, DORAL RENEE (FNP)
Entity type:Individual
Prefix:MS
First Name:DORAL
Middle Name:RENEE
Last Name:GONZALES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:DORAL
Other - Middle Name:RENEE
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:1709 VIA MILANO
Mailing Address - Street 2:
Mailing Address - City:GUSTINE
Mailing Address - State:CA
Mailing Address - Zip Code:95322-9682
Mailing Address - Country:US
Mailing Address - Phone:408-348-1894
Mailing Address - Fax:209-854-6805
Practice Address - Street 1:930 SUNSET DR
Practice Address - Street 2:BUILDING # 3
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5780
Practice Address - Country:US
Practice Address - Phone:831-636-2664
Practice Address - Fax:831-636-2641
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 348323163WC1500X
CANP 13815363LF0000X
CANM 1248363LP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No363LP1700XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPerinatal