Provider Demographics
NPI:1851482467
Name:GONZALES, JANICE LORENE (RD)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:LORENE
Last Name:GONZALES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1233
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1775 THOMPSON ROAD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:WA
Practice Address - Zip Code:97420
Practice Address - Country:US
Practice Address - Phone:541-269-8508
Practice Address - Fax:541-266-7829
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered