DR. KELLY D GONZALES (NPI# 1194109702) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194109702 |
| Entity Type | Individual |
| Full Name | DR. KELLY D GONZALES |
| Credential | DNP |
| Practice Address |
4282 Genesee Ave Ste 103 San Diego CA 92117 |
| Mailing Address |
4282 Genesee Ave Ste 103 San Diego CA 92117-4961 |
| Practice Telephone | 8582920108 |
| Practice Fax Number | 8582929097 |
| Mailing Telephone | 8582920108 |
| Mailing Fax Number | 8582929097 |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2018-06-12 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
95002691 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
95002691 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770192841 | Kelly Gonzales | Behavior Technician | 8885 Rio San Diego Dr Ste 340, San Diego, CA 92108-1669 | 2020-07-24 |
| 1669887584 | Kelly Gonzales | Nurse Practitioner | 985330 Nebraska Medical Ctr, Omaha, NE 68198-5330 | 2014-06-30 |
| 1497088868 | Kelly Herzstein Gonzales | Counselor | 7225 N 1st St, Suite 101, Fresno, CA 93720-2986 | 2009-09-16 |
| 1184899874 | Kelly De Gonzales | Surgery | 150 N Jackson Ave, Suite 100, San Jose, CA 95116-1908 | 2008-04-24 |
| 1417128687 | Kelly Marie Gonzales | Dentist | 1103 Rivery Blvd, Ste. 140, Georgetown, TX 78628-3034 | 2008-03-17 |
| 1720188295 | Kelly Aileen Gonzales | Physician Assistant | 5207 Heritage Ave, Colleyville, TX 76034 | 2006-09-25 |
| Street Address |
4282 GENESEE AVE STE 103 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92117 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154956050 | Enbara Corporation | Dentist | 5189 Clairmont Mesa Blvd, San Diego, CA 92117 | 2020-03-11 |
| 1568956050 | Lourdes C Villagran | Case Manager/Care Coordinator | 4474 Charger Blvd, San Diego, CA 92117 | 2018-06-18 |
| 1750893509 | Dzendzel Family Chiropractic | Chiropractor | 3650 Clairemont Drive, Ste 2, San Diego, CA 92117 | 2017-11-02 |
| 1205355401 | Alan Ford | Counselor | 4150 Ute Dr., San Diego, CA 92117 | 2017-09-19 |
| 1780101238 | Allison Dawn Heeney | Occupational Therapist | 3386 Hopi Place, San Diego, CA 92117 | 2017-08-25 |
| 1275074379 | Rachel Gabrielle Packer | Counselor | 5252 Balboa Ave Ste 801, San Diego, CA 92117 | 2017-03-09 |
| 1316482995 | Lisa Graff-marsh, Inc. | Social Worker | 4985 Park Rim Dr., San Diego, CA 92117 | 2017-01-05 |
| 1417408949 | Markos and Markos 1 Inc | Private Vehicle | 4495 Clairemont Mesa Blvd, San Diego, CA 92117 | 2016-10-19 |
| 1801341813 | Huynh and Habashi Dental Corporation | Dentist | 2995 Clairemont Dr, Suite A, San Diego, CA 92117 | 2016-08-19 |
| 1184076077 | Tammy Monck | Optometrist | 3952 Clairemont Mesa Blvd Ste I, San Diego, CA 92117 | 2016-07-05 |
| Find all providers in zip 92117 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982203097 | Rebecca Dolores Garcia | Nurse Practitioner | 2440 Curlew St, San Diego, CA 92101-1327 | 2020-10-20 |
| 1003415472 | Ryanleo Flores | Nurse Practitioner | 2017 1st Avenue, Suite 301, San Diego, CA 92101 | 2020-10-18 |
| 1083226245 | Allison Floyd | Nurse Practitioner | 3652 Texas St, San Diego, CA 92104-4044 | 2020-08-19 |
| 1386255248 | Helen Hyeyoung Hong | Nurse Practitioner | 5140 Caminito Exquisito, San Diego, CA 92130-2852 | 2020-08-13 |
| 1134747595 | Dawn Elyse Rose | Nurse Practitioner | 8260 Mira Mesa Blvd Ste A, San Diego, CA 92126-2662 | 2020-07-10 |
| 1982232591 | John Meier | Nurse Practitioner | 3745 Riviera Dr Apt 10, San Diego, CA 92109-6661 | 2020-03-30 |
| 1013543008 | Alex Choi Mara | Nurse Practitioner | 5248 Zephyr Ln Unit 24, San Diego, CA 92120-2749 | 2020-03-21 |
| 1669005021 | Katlyn Ann Hartman | Nurse Practitioner | 1951 4th Ave, San Diego, CA 92101-2374 | 2020-02-13 |
| 1245876101 | Katherine Baber | Nurse Practitioner | 3671 Fifth Ave, San Diego, CA 92103-4218 | 2019-11-25 |
| 1922644095 | Taiko Harris | Nurse Practitioner | 13592 Bolero Way, San Diego, CA 92130-7006 | 2019-11-22 |
| Find all providers in SAN DIEGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.