| 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: | |