=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043164064
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEANINE WYNN GONZALES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2026
-----------------------------------------------------
Last Update Date | 02/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36987 HIGHWAY 299 E
-----------------------------------------------------
City | BURNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96013-4051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-338-7873
-----------------------------------------------------
Fax | 530-983-1666
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36987 HIGHWAY 299 E
-----------------------------------------------------
City | BURNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96013-4051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-338-7873
-----------------------------------------------------
Fax | 530-983-1666
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------