Provider Demographics
NPI:1871474486
Name:GONZALES, ANGELO (PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:ANGELO
Middle Name:
Last Name:GONZALES
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 WESTERN FRONT ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-3335
Mailing Address - Country:US
Mailing Address - Phone:408-466-5941
Mailing Address - Fax:
Practice Address - Street 1:4445 WESTERN FRONT ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-3335
Practice Address - Country:US
Practice Address - Phone:408-466-5941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV893735363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty