Provider Demographics
NPI:1760228142
Name:GONZALEZ, SARAH ALEXIAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ALEXIAH
Last Name:GONZALEZ
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 1:1807 SEVILLE DR
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-4257
Mailing Address - Country:US
Mailing Address - Phone:707-287-4523
Mailing Address - Fax:
Practice Address - Street 1:1222 PINE ST STE A
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-1830
Practice Address - Country:US
Practice Address - Phone:707-963-0931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95329496163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse