Provider Demographics
NPI:1407447915
Name:GONZALES, JEANNETTE LOPEZ
Entity Type:Individual
Prefix:MS
First Name:JEANNETTE
Middle Name:LOPEZ
Last Name:GONZALES
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 1:29325 KIMBERLINA RD
Mailing Address - Street 2:
Mailing Address - City:WASCO
Mailing Address - State:CA
Mailing Address - Zip Code:93280-7617
Mailing Address - Country:US
Mailing Address - Phone:661-758-4029
Mailing Address - Fax:
Practice Address - Street 1:29325 KIMBERLINA RD
Practice Address - Street 2:
Practice Address - City:WASCO
Practice Address - State:CA
Practice Address - Zip Code:93280-7617
Practice Address - Country:US
Practice Address - Phone:661-758-4029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker