Healthcare Provider Details

I. General information

NPI: 1679081913
Provider Name (Legal Business Name): JESSICA YESENIA GONZALEZ CNM, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA YESENIA RIVAS CNM, WHNP-BC

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9455 CLAIREMONT MESA BLVD
SAN DIEGO CA
92123-1297
US

IV. Provider business mailing address

9455 CLAIREMONT MESA BLVD
SAN DIEGO CA
92123-1297
US

V. Phone/Fax

Practice location:
  • Phone: 858-266-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236123
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number766166
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number766166
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: