Provider Demographics
NPI:1487294591
Name:GONZALEZ, CALLIE R (NP)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:R
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44045 MARGARITA RD
Mailing Address - Street 2:STE 203
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-2730
Mailing Address - Country:US
Mailing Address - Phone:951-698-1901
Mailing Address - Fax:951-698-1074
Practice Address - Street 1:44045 MARGARITA RD STE 203
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-2730
Practice Address - Country:US
Practice Address - Phone:951-262-4488
Practice Address - Fax:951-262-4414
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95013535363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner