Provider Demographics
NPI:1053766527
Name:GONZALES, TINA MARIE (LVN)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MARIE
Last Name:GONZALES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1000
Mailing Address - Country:US
Mailing Address - Phone:661-868-6601
Mailing Address - Fax:661-868-6666
Practice Address - Street 1:17695 INDUSTRIAL FARM RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-9520
Practice Address - Country:US
Practice Address - Phone:661-391-7948
Practice Address - Fax:661-391-7978
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN274551164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVN274551OtherLVN