Samantha Sison Gonzalez

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

95046286 Issued in CA

Practice address

150 W Route 66
Glendora, CA 91740-6207

Phone

(626) 852-5000

NPI assigned

Mar 12, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1710201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710201600000",
    "number": "1023876216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5017 AGAVE AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923365962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 W ROUTE 66",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917406207",
            "telephone_number": "626-852-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SISON GONZALEZ",
        "first_name": "SAMANTHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-12",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95046286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• James F. Skalicky, PH.D.
• Natalia Slusky, DDS
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• Olivia Carmen Smith, ATC

• Psychiatric/Mental Health Registered Nurse in Glendora, CA
• Providers in Glendora, CA by specialty
• Psychiatric/Mental Health Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.