Provider Demographics
NPI:1750976973
Name:GONZALEZ, JORGE. ALBERTO
Entity type:Individual
Prefix:
First Name:JORGE.
Middle Name:ALBERTO
Last Name:GONZALEZ
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 1:17635 INDUSTRIAL FARM RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-9520
Mailing Address - Country:US
Mailing Address - Phone:661-490-7262
Mailing Address - Fax:
Practice Address - Street 1:5103 APPLEBLOSSOM DR APT 1
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-5852
Practice Address - Country:US
Practice Address - Phone:661-490-7262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)