1780593418 NPI number — MR. NICOLAS DAVID GONZALES II CBT.CB.70165722

Table of content: MR. NICOLAS DAVID GONZALES II CBT.CB.70165722 (NPI 1780593418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780593418 NPI number — MR. NICOLAS DAVID GONZALES II CBT.CB.70165722

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALES
Provider First Name:
NICOLAS
Provider Middle Name:
DAVID
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
II
Provider Credential Text:
CBT.CB.70165722
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780593418
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 988
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PULLMAN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99163-0988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-200-6976
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
506 N SULLIVAN RD
Provider Second Line Business Practice Location Address:
STE F 139
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99037-8543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-200-6976
Provider Business Practice Location Address Fax Number:
772-675-9100
Provider Enumeration Date:
09/08/2026

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X , with the licence number:  CBT.CB.70165722 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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