Provider Demographics
NPI:1528215472
Name:GONZALEZ, JORGE R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:R
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 W SHAW AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-2398
Mailing Address - Country:US
Mailing Address - Phone:559-575-0475
Mailing Address - Fax:
Practice Address - Street 1:790 W SHAW AVE STE 280
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-2398
Practice Address - Country:US
Practice Address - Phone:559-575-0475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19965103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical