Individual
MR. CLIFFORD FONTANILLA GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-3069
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-3069
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
136101
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
2163
NC
Other
Enumeration date
10/06/2006
Last updated
06/19/2025
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