Provider Demographics
NPI:1750170411
Name:GONZAGA, KRISTYN P (NP)
Entity type:Individual
Prefix:MRS
First Name:KRISTYN
Middle Name:P
Last Name:GONZAGA
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 1:6 ASBURY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-1620
Mailing Address - Country:US
Mailing Address - Phone:818-370-0179
Mailing Address - Fax:
Practice Address - Street 1:6 ASBURY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-1620
Practice Address - Country:US
Practice Address - Phone:818-370-0179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032936363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care