Basic Information
| Provider Information | |||||||||
| NPI: | 1972645927 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALES | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | ANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1770 NORVAL ST | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917665527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098658620 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1517 W GARVEY AVE N | ||||||||
| Address2: | |||||||||
| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917902138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269626061 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | VN223987 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.