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General NPI Number Information
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NPI Number | 1164905121
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Entity Type | Individual
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Provider Name | JONARD YLARDE GONZALES
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Gender | Male
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Dates
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Enumeration Date | 09/14/2018
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 6240 N DURANGO DR STE 120
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City | LAS VEGAS
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State | NV
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Zip | 89149-3941
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Country | US
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Telephone | 954-923-7440
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Fax | 954-923-1299
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Provider Business Mailing Address
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Address Line | 8432 CAMBRIA CELLARS CT
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City | LAS VEGAS
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State | NV
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Zip | 89139-7164
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Country | US
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Telephone | 702-493-6071
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 813530
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License Number State | NV
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