Active NPI
Sam Robert Gonzales, CNA
- Nurse's Aide
- Grass Valley, CA
National Provider Identifier
1881589539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse's Aide
- License
- 01224031
- Practice address
- 159 Brentwood Dr
Grass Valley, CA 95945-5703 - Phone
- (530) 460-4082
- Fax
- (530) 273-9541
- NPI assigned
- Jun 12, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | 01224031 | CA | Primary |
Addresses
Primary practice location
159 Brentwood Dr
Grass Valley, CA 95945-5703
Mailing address
159 Brentwood Dr
Grass Valley, CA 95945-5703
Phone (530) 460-4082
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01224031 | CA | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1749686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1749686400000",
"number": "1881589539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "159 BRENTWOOD DR",
"city": "GRASS VALLEY",
"state": "CA",
"postal_code": "959455703",
"telephone_number": "530-460-4082",
"fax_number": "530-273-5410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "159 BRENTWOOD DR",
"city": "GRASS VALLEY",
"state": "CA",
"postal_code": "959455703",
"telephone_number": "530-460-4082",
"fax_number": "530-273-9541"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALES",
"first_name": "SAM",
"middle_name": "ROBERT",
"credential": "CNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-06-12",
"last_updated": "2025-06-12",
"certification_date": "2025-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "CA",
"license": "01224031",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grass Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.