Provider Demographics
NPI:1487987764
Name:GONZALES, ANALYN BAYANI
Entity type:Individual
Prefix:
First Name:ANALYN
Middle Name:BAYANI
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 1:2851 MEADOW LARK DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2709
Mailing Address - Country:US
Mailing Address - Phone:858-571-1964
Mailing Address - Fax:858-571-1967
Practice Address - Street 1:2851 MEADOW LARK DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2709
Practice Address - Country:US
Practice Address - Phone:858-571-1964
Practice Address - Fax:858-571-1967
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN19087164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse