Provider Demographics
NPI:1154196509
Name:GONZALEZ-HERNANDEZ, JESSICA (PA-S2)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GONZALEZ-HERNANDEZ
Suffix:
Gender:F
Credentials:PA-S2
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-S2
Mailing Address - Street 1:40 PARK CITY CT APT 6107
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-6104
Mailing Address - Country:US
Mailing Address - Phone:857-472-4071
Mailing Address - Fax:
Practice Address - Street 1:40 PARK CITY CT APT 6107
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-6104
Practice Address - Country:US
Practice Address - Phone:857-472-4071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program