NPI Code Detail JSON Logo

1558908368 NPI number — JOE ANTHONY GONZALES FNP

NPI Number: 1558908368
Health Care Provider/Practitioner: JOE ANTHONY GONZALES FNP

Information about “1558908368” NPI (JOE ANTHONY GONZALES FNP) exists in 1558908368 in HTML format HTML  |  1558908368 in plain Text format TXT  |  1558908368 in PDF (Portable Document Format) PDF  |  1558908368 in an XML format XML  formats.

NPI Number : 1558908368 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1558908368",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GONZALES",
    "FirstName": "JOE",
    "MiddleName": "ANTHONY",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "FNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4225 EXECUTIVE SQ STE 450",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LA JOLLA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92037-8411",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "858-810-8000",
    "MailingAddressFaxNumber": "858-268-1911",
    "FirstLinePracticeLocationAddress": "207 W LEGION RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BRAWLEY",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92227-7780",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "760-351-3333",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/30/2019",
    "LastUpdateDate": "02/28/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "95012008",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "NP95012008",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.