Healthcare Provider Details

I. General information

NPI: 1053711069
Provider Name (Legal Business Name): JACQUELINE GONZALEZ N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14445 OLIVE VIEW DR
SYLMAR CA
91342-1437
US

IV. Provider business mailing address

14445 OLIVE VIEW DR
SYLMAR CA
91342-1437
US

V. Phone/Fax

Practice location:
  • Phone: 818-364-3031
  • Fax:
Mailing address:
  • Phone: 747-210-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95001151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: