Healthcare Provider Details

I. General information

NPI: 1578436523
Provider Name (Legal Business Name): JESSICA YESENIA GONZALEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71777 SAN JACINTO DR STE 202
RANCHO MIRAGE CA
92270-4457
US

IV. Provider business mailing address

43465 TENNESSEE AVE
PALM DESERT CA
92211-7767
US

V. Phone/Fax

Practice location:
  • Phone: 760-396-7394
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number95227500
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: