MEDICARE: DR. JAYMES GONZALES PH.D.

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
1	103TC0700X	Clinical Psychologist	20043323B	IN
2	103TC0700X	Clinical Psychologist	9065	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598019838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAYMES GONZALES PH.D.

Provider Business Mailing Address
First Line	:	3115 INNOVATION DR
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-6501
Country	:	US
Telephone Number	:	407-892-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	3115 INNOVATION DR
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-6501
Country	:	US
Telephone Number	:	407-530-7304
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2012
Last Update Date	:	05/18/2023

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