Provider Demographics
NPI:1871947291
Name:GONZALES, CECILIO PARROCHA JR (APRN,FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CECILIO
Middle Name:PARROCHA
Last Name:GONZALES
Suffix:JR
Gender:M
Credentials:APRN,FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7521 SLIPPER ORCHID ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2616
Mailing Address - Country:US
Mailing Address - Phone:619-259-7118
Mailing Address - Fax:
Practice Address - Street 1:2820 W CHARLESTON BLVD STE D40
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1942
Practice Address - Country:US
Practice Address - Phone:725-205-0288
Practice Address - Fax:725-204-9792
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF95003567363L00000X
NYF340204-1363LF0000X
HI2169363LF0000X, 363LP0808X
NV002915363LP0808X, 363LF0000X, 363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1871947291Medicaid
NV250010762Medicaid