Doctor Name: | JACQUELINE GONZALEZ |
NPI Number: | 1053711069 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | N.P. |
License Number: | 95001151 |
Business Practice Address: | 14445 Olive View Dr Sylmar, CA - 913421437 |
Business Phone Number: | 8183643031 |
Business Fax Number: | |
Mailing Address: | 19029 Nordhoff St Unit 110, NORTHRIDGE |
State: | CA |
Postal Code: | 913244803 |
Phone Number: | 8185151481 |
Fax Number: | |
NPI Enumeration Date: | 08/27/2014 |
NPI Last Update Date: | 08/27/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 95001151 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |