Provider Demographics
NPI:1811497522
Name:GONZALES, ISAAC JENKIN TENA (RN)
Entity type:Individual
Prefix:
First Name:ISAAC JENKIN
Middle Name:TENA
Last Name:GONZALES
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9809 RICHMOND AVE UNIT B14
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-4567
Mailing Address - Country:US
Mailing Address - Phone:832-296-4977
Mailing Address - Fax:
Practice Address - Street 1:9809 RICHMOND AVE UNIT B14
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-4567
Practice Address - Country:US
Practice Address - Phone:832-296-4977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX844655163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse