Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 95004636 | CA |
NPI | 1003367939 |
---|---|
Provider Name | Mr. Christopher Gerard Gonzales |
First Address | Sunnyvale, CA 94087-2713 |
Second Address | Palo Alto, CA 94304-1207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2016 |
Last Update Date | 14/10/2016 |