Provider Demographics
NPI:1083968036
Name:GONZALEZ, JOSCELYN DANIELA
Entity Type:Individual
Prefix:
First Name:JOSCELYN
Middle Name:DANIELA
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 1:1415 HICKEY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7176
Mailing Address - Country:US
Mailing Address - Phone:702-502-6846
Mailing Address - Fax:
Practice Address - Street 1:1415 HICKEY AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGS
Practice Address - State:NV
Practice Address - Zip Code:89030-7176
Practice Address - Country:US
Practice Address - Phone:702-502-6846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst