Provider Demographics
NPI:1447142948
Name:GONZALES, STEVEN MICHAEL (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:MICHAEL
Last Name:GONZALES
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 S AVENUE 55 APT 7
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-4643
Mailing Address - Country:US
Mailing Address - Phone:909-313-8943
Mailing Address - Fax:909-313-8943
Practice Address - Street 1:1983 MARENGO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1370
Practice Address - Country:US
Practice Address - Phone:909-313-8943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95036226363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care