Healthcare Provider Details

I. General information

NPI: 1124851951
Provider Name (Legal Business Name): JONAS ANTON GOSSCHALK RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N LOVERS LN
VISALIA CA
93292-8013
US

IV. Provider business mailing address

2515 W FAIRVIEW AVE
VISALIA CA
93277-2013
US

V. Phone/Fax

Practice location:
  • Phone: 559-730-7851
  • Fax:
Mailing address:
  • Phone: 210-330-7805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number95127437
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number95127437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: