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General NPI Number Information
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NPI Number | 1447912100
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Entity Type | Individual
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Provider Name | JOSE MANUEL GONZALEZ-MARTINEZ FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 10/11/2021
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Last Update Date | 10/19/2021
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Provider Practice Location Address
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Address Line | 147 LEE TRACE DR
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City | SMITHFIELD
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State | NC
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Zip | 27577-9519
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Country | US
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Telephone | 818-390-3071
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Fax |
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Provider Business Mailing Address
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Address Line | 147 LEE TRACE DR
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City | SMITHFIELD
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State | NC
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Zip | 27577-9519
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Country | US
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Telephone | 818-390-3071
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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 | GONZ-UYV3E
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License Number State | NC
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