Provider Demographics
NPI:1477030500
Name:GONZALEZ, CHRIS J
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:J
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 1:2855 W GRANGER ST
Mailing Address - Street 2:
Mailing Address - City:CARUTHERS
Mailing Address - State:CA
Mailing Address - Zip Code:93609-9474
Mailing Address - Country:US
Mailing Address - Phone:559-589-3713
Mailing Address - Fax:
Practice Address - Street 1:2855 W GRANGER ST
Practice Address - Street 2:
Practice Address - City:CARUTHERS
Practice Address - State:CA
Practice Address - Zip Code:93609-9474
Practice Address - Country:US
Practice Address - Phone:559-589-3713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-21
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty