Provider Demographics
NPI:1629731377
Name:GONZALEZ, JORGE ARMANDO (LPN)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:ARMANDO
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11445 GENE SARAZEN DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4732
Mailing Address - Country:US
Mailing Address - Phone:915-270-3026
Mailing Address - Fax:
Practice Address - Street 1:11445 GENE SARAZEN DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4732
Practice Address - Country:US
Practice Address - Phone:915-270-3026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX327700164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse