Provider Demographics
NPI:1922752799
Name:GONZALEZ, JESUS (MS)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 1/2 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-2234
Mailing Address - Country:US
Mailing Address - Phone:509-731-2429
Mailing Address - Fax:
Practice Address - Street 1:300 W HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99251-2515
Practice Address - Country:US
Practice Address - Phone:509-777-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer