Provider Demographics
NPI:1447636121
Name:GONZALEZ, LUCIO CESAR (FNP)
Entity type:Individual
Prefix:
First Name:LUCIO
Middle Name:CESAR
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 E 149TH ST PSYCHIATRY
Mailing Address - Street 2:ROOM 7B-100
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5504
Mailing Address - Country:US
Mailing Address - Phone:718-579-5270
Mailing Address - Fax:
Practice Address - Street 1:HH LINCOLN . 234 E 149TH STREET
Practice Address - Street 2:PSYCHIATRY DEPARTMENT. ROOM 7B-100
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:718-579-5270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342355363LF0000X
NY403419363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health