Provider Demographics
NPI:1699394932
Name:GONZALEZ, MATTHEW STEFAN CRUZ
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:STEFAN CRUZ
Last Name:GONZALEZ
Suffix:
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 1:206 FAIRFAX AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4077
Mailing Address - Country:US
Mailing Address - Phone:606-308-5194
Mailing Address - Fax:
Practice Address - Street 1:719 THOMPSON LN POD C
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-4600
Practice Address - Country:US
Practice Address - Phone:615-936-1212
Practice Address - Fax:615-936-9431
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program