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NPI Code Detail

MEDICARE: JENNIFER MARIE GONZALEZ CNIM, R.EP.T

MEDICARE: JENNIFER MARIE GONZALEZ CNIM, R.EP.T
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1246ZE0600XElectroneurodiagnostic Specialist/Technologist1703AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11703OTHERAZABRET

General Provider Information

NPI Number : 1558080671
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MARIE GONZALEZ CNIM, R.EP.T
Provider Business Mailing Address
First Line : 8655 E VIA DE VENTURA STE E160
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85258-3395
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8655 E VIA DE VENTURA STE E160
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85258-3395
Country : US
Telephone Number : 480-596-1686
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2022
Last Update Date : 04/14/2023

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