Provider Demographics
NPI:1578038139
Name:GONZALEZ, JORGE (RBT)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3934 MURPHY CANYON RD
Mailing Address - Street 2:STE B202
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:619-598-2924
Mailing Address - Fax:619-795-0814
Practice Address - Street 1:3934 MURPHY CANYON RD
Practice Address - Street 2:STE B202
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:619-598-2924
Practice Address - Fax:619-795-0814
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician