Healthcare Provider Details

I. General information

NPI: 1720999261
Provider Name (Legal Business Name): DAMASO GONZALEZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 E INDIAN TRL
AURORA IL
60505-1732
US

IV. Provider business mailing address

440 JACKSON ST
AURORA IL
60505-4730
US

V. Phone/Fax

Practice location:
  • Phone: 630-300-3400
  • Fax:
Mailing address:
  • Phone: 630-770-4112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-385408
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: