Provider Demographics
NPI:1952870263
Name:GONZALEZ, JOSHUA ENRIQUE
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ENRIQUE
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 1:932 BEACH ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-1502
Mailing Address - Country:US
Mailing Address - Phone:810-238-5888
Mailing Address - Fax:810-410-1493
Practice Address - Street 1:1320 MARTIN LUTHER KING AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-1448
Practice Address - Country:US
Practice Address - Phone:908-305-1182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist