Provider Demographics
NPI:1528282951
Name:GONZALEZ, JENNEFER JANET
Entity type:Individual
Prefix:
First Name:JENNEFER
Middle Name:JANET
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3337 KELLIE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSAMOND
Mailing Address - State:CA
Mailing Address - Zip Code:93560-6843
Mailing Address - Country:US
Mailing Address - Phone:661-256-3376
Mailing Address - Fax:
Practice Address - Street 1:2689 SIERRA HWY.
Practice Address - Street 2:
Practice Address - City:ROSAMOND
Practice Address - State:CA
Practice Address - Zip Code:93560
Practice Address - Country:US
Practice Address - Phone:661-256-7208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator