Provider Demographics
NPI:1124440706
Name:GONZALES, JESSICA JOY (LM, CPM)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:JOY
Last Name:GONZALES
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 MAPLERIDGE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-4629
Mailing Address - Country:US
Mailing Address - Phone:832-899-4971
Mailing Address - Fax:
Practice Address - Street 1:4108 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1906
Practice Address - Country:US
Practice Address - Phone:713-253-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
TX99555176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula