Basic Information
| Provider Information | |||||||||
| NPI: | 1467170985 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | MATIAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1311 11TH ST | ||||||||
| Address2: | |||||||||
| City: | REEDLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936542926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8553431057 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1311 11TH ST | ||||||||
| Address2: | |||||||||
| City: | REEDLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936542926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8553431057 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2022 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 726363 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.