Healthcare Provider Details

I. General information

NPI: 1295321347
Provider Name (Legal Business Name): JONATHAN GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 S HOUGHTON RD
TUCSON AZ
85748-7632
US

IV. Provider business mailing address

PO BOX 840857
DALLAS TX
75284-0857
US

V. Phone/Fax

Practice location:
  • Phone: 205-436-1005
  • Fax:
Mailing address:
  • Phone: 702-878-0070
  • Fax: 702-209-2064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26384
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number836627
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number291437
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: