Provider Demographics
NPI:1831760578
Name:GONZALEZ, JONATHAN ANTHONY (MS, RDN, LD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ANTHONY
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 KINGWOOD DR APT 1124
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3722
Mailing Address - Country:US
Mailing Address - Phone:832-318-9160
Mailing Address - Fax:
Practice Address - Street 1:120 SAN LUCAR CT
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-5213
Practice Address - Country:US
Practice Address - Phone:855-816-7705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-04
Last Update Date:2021-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84048133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered