Provider Demographics
NPI:1023842184
Name:GONZALEZ-MONTENBRUCK, JONATHAN MARTIN
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MARTIN
Last Name:GONZALEZ-MONTENBRUCK
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 1:124 S LAKE MERCED HLS
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-2935
Mailing Address - Country:US
Mailing Address - Phone:415-385-2740
Mailing Address - Fax:
Practice Address - Street 1:500 CROWN POINT CIR STE 100
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-9561
Practice Address - Country:US
Practice Address - Phone:530-273-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program