Provider Demographics
NPI:1669235107
Name:GONZALEZ, JOSE UDDIEL (NONE)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:UDDIEL
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:NONE
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7525 HASKELL AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3255
Mailing Address - Country:US
Mailing Address - Phone:213-925-2084
Mailing Address - Fax:
Practice Address - Street 1:7525 HASKELL AVE APT 103
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3255
Practice Address - Country:US
Practice Address - Phone:213-925-2084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst