Healthcare Provider Details

I. General information

NPI: 1336084086
Provider Name (Legal Business Name): DANIEL GONZALES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1293 SOUTHWIND DR
ST GEORGE UT
84770-4902
US

IV. Provider business mailing address

1293 SOUTHWIND DR
ST GEORGE UT
84770-4902
US

V. Phone/Fax

Practice location:
  • Phone: 435-313-7114
  • Fax:
Mailing address:
  • Phone: 435-313-7114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2278E0002X
TaxonomyEmergency Care Certified Respiratory Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: