Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 20800000X | TX |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 95010359 | CA |
NPI | 1225553605 |
---|---|
Provider Name | Tasha Gonzales |
First Address | Los Angeles, CA 90027-6062 |
Second Address | Los Angeles, CA 90027-6062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2017 |
Last Update Date | 11/01/2022 |