Provider Demographics
NPI:1053940254
Name:GONZAGA, MA. CATHERINE (RN, BSN)
Entity type:Individual
Prefix:
First Name:MA. CATHERINE
Middle Name:
Last Name:GONZAGA
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 HARRISON AVE APT E3
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1724
Mailing Address - Country:US
Mailing Address - Phone:646-725-7982
Mailing Address - Fax:
Practice Address - Street 1:25019 HOOK CREEK BLVD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2631
Practice Address - Country:US
Practice Address - Phone:718-978-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY704673163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health