Provider Demographics
NPI:1497077515
Name:GONZALEZ, JORGE VALENCIANO
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:VALENCIANO
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 1:1403 LOOKOUT
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-2308
Mailing Address - Country:US
Mailing Address - Phone:956-648-7554
Mailing Address - Fax:
Practice Address - Street 1:1403 LOOKOUT
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-2308
Practice Address - Country:US
Practice Address - Phone:956-648-7554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker