Provider Demographics
NPI:1023321890
Name:GONZALES, JERRY PUENTE (LTC (RET), RN, MS)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:PUENTE
Last Name:GONZALES
Suffix:
Gender:M
Credentials:LTC (RET), RN, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14747 OAK BRIAR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4679
Mailing Address - Country:US
Mailing Address - Phone:210-490-3048
Mailing Address - Fax:
Practice Address - Street 1:14747 OAK BRIAR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-4679
Practice Address - Country:US
Practice Address - Phone:210-490-3048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230082163WA2000X, 163WC1600X, 163WG0000X, 163WM0705X, 163WN1003X, 163WP2201X
VA230082163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care