Provider Demographics
NPI:1326834185
Name:GONZALEZ, JACOB ALLEN (PCT, CET, CPT, BLS)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:ALLEN
Last Name:GONZALEZ
Suffix:
Gender:
Credentials:PCT, CET, CPT, BLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 WEST AVE
Mailing Address - Street 2:#113197 SMB#82886
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06911
Mailing Address - Country:US
Mailing Address - Phone:203-635-3548
Mailing Address - Fax:
Practice Address - Street 1:317 WEST AVE
Practice Address - Street 2:#113197 SMB#82886
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06911
Practice Address - Country:US
Practice Address - Phone:203-635-3548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-17
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3747P1801X, 374U00000X, 246RP1900X
CTELECTROCARDIOGRAM374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No374700000XNursing Service Related ProvidersTechnician