Provider Demographics
NPI:1689385940
Name:GONZALEZ, JESSE JR
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:GONZALEZ
Suffix:JR
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 1:690 HAYDEN AVE
Mailing Address - Street 2:
Mailing Address - City:MC FARLAND
Mailing Address - State:CA
Mailing Address - Zip Code:93250-1685
Mailing Address - Country:US
Mailing Address - Phone:661-375-2157
Mailing Address - Fax:
Practice Address - Street 1:1601 NEW STINE RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-3696
Practice Address - Country:US
Practice Address - Phone:661-375-2157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician