Provider Demographics
NPI:1316758303
Name:GONZALES, ELEANOR MALIXI
Entity type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:MALIXI
Last Name:GONZALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5407 GLENBURNIE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-7600
Mailing Address - Country:US
Mailing Address - Phone:702-334-8216
Mailing Address - Fax:
Practice Address - Street 1:5407 GLENBURNIE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-7600
Practice Address - Country:US
Practice Address - Phone:702-334-8216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17171164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse