Provider Demographics
NPI:1962280123
Name:GONZALEZ, ANABEL (RN, PHN)
Entity type:Individual
Prefix:
First Name:ANABEL
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1548 AUTUMN SKY LN
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1951
Mailing Address - Country:US
Mailing Address - Phone:619-339-4220
Mailing Address - Fax:
Practice Address - Street 1:5560 OVERLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1204
Practice Address - Country:US
Practice Address - Phone:858-505-6367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95230961163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse