Provider Demographics
NPI:1780662064
Name:GONZALES, JAIME MARCOS (MS, CGC)
Entity Type:Individual
Prefix:MR
First Name:JAIME
Middle Name:MARCOS
Last Name:GONZALES
Suffix:
Gender:M
Credentials:MS, CGC
Other - Prefix:MR
Other - First Name:MARCOS
Other - Middle Name:
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS,CGC
Mailing Address - Street 1:3697 CAMINITO CARMEL LNDG
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6507 MISSION GORGE RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-2306
Practice Address - Country:US
Practice Address - Phone:619-528-6471
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS