Provider Demographics
NPI:1033248471
Name:GONZALEZ, JON RAFAEL (RN)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:RAFAEL
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 OREGON ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-3019
Mailing Address - Country:US
Mailing Address - Phone:619-252-9960
Mailing Address - Fax:
Practice Address - Street 1:4420 OREGON ST APT 3
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-3019
Practice Address - Country:US
Practice Address - Phone:619-252-9960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA219354164X00000X
CA740992163W00000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management