Provider Demographics
NPI:1194284802
Name:GONZALEZ, JESSICA MARIA (LVN)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MARIA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARIA
Other - Last Name:BONUGLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1933 COTTONWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-4495
Mailing Address - Country:US
Mailing Address - Phone:210-577-9855
Mailing Address - Fax:
Practice Address - Street 1:1933 COTTONWOOD WAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-4495
Practice Address - Country:US
Practice Address - Phone:210-577-9855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX328955164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse