Individual
DANIEL A GONGORA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LVN
Contact information
Practice address
720 WOOD ST, EUREKA, CA 95501-4413
(000) 000-0000
Mailing address
PO BOX 554, SMITH RIVER, CA 95567-0554
(707) 954-5940
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
169269
CA
Other
Enumeration date
11/15/2019
Last updated
11/15/2019
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