Provider Demographics
NPI:1528443165
Name:GONZALEZ, OSCAR JESUS
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:JESUS
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 WILLAMETTE ST STE A
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-5109
Mailing Address - Country:US
Mailing Address - Phone:541-686-5060
Mailing Address - Fax:541-686-5063
Practice Address - Street 1:3411 WILLAMETTE ST STE A
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-5109
Practice Address - Country:US
Practice Address - Phone:541-686-5060
Practice Address - Fax:541-686-5063
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health