Healthcare Provider Details

I. General information

NPI: 1821889395
Provider Name (Legal Business Name): JENNY GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 E ALONDRA BLVD
COMPTON CA
90221-4229
US

IV. Provider business mailing address

5425 POMONA BLVD
LOS ANGELES CA
90022-1716
US

V. Phone/Fax

Practice location:
  • Phone: 323-765-6164
  • Fax:
Mailing address:
  • Phone: 323-728-0411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number95203468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: