Provider Demographics
NPI:1578735718
Name:GONZALEZ-JACQUEZ, MARIA ELIZABETH (LVN)
Entity Type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:ELIZABETH
Last Name:GONZALEZ-JACQUEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3433 W SHAW AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3229
Mailing Address - Country:US
Mailing Address - Phone:559-558-4051
Mailing Address - Fax:
Practice Address - Street 1:496 S BARTON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702-2985
Practice Address - Country:US
Practice Address - Phone:559-860-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201808164X00000X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse