Provider Demographics
NPI:1942454202
Name:GONZALEZ, CANDIDA I (LPN)
Entity type:Individual
Prefix:
First Name:CANDIDA
Middle Name:I
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARL R. DARNALL ARMY MEDICAL CENTER
Mailing Address - Street 2:36065 SANTA FE AVE.
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-5333
Mailing Address - Country:US
Mailing Address - Phone:254-553-8110
Mailing Address - Fax:254-553-8111
Practice Address - Street 1:5200 BUNY TRAIL
Practice Address - Street 2:WEST KILLEEN MEDICAL HOME
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:36362-5333
Practice Address - Country:US
Practice Address - Phone:254-553-8110
Practice Address - Fax:254-553-8111
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR023691164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse