Provider Demographics
NPI:1992676290
Name:GONZALES, KYLE ANTHONY (DNP, PMHNP-BC, RN)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:ANTHONY
Last Name:GONZALES
Suffix:
Gender:X
Credentials:DNP, PMHNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9772 LASORDA CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-0003
Mailing Address - Country:US
Mailing Address - Phone:951-415-2424
Mailing Address - Fax:
Practice Address - Street 1:9772 LASORDA CT
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-0003
Practice Address - Country:US
Practice Address - Phone:951-415-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95035972363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health