MEDICARE: JONATHAN GONZALEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	26384	SC
2	367500000X	Certified Registered Nurse Anesthetist	836627	NV
3	367500000X	Certified Registered Nurse Anesthetist	291437	AZ
4	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1295321347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN GONZALEZ

Provider Business Mailing Address
First Line	:	3956 REDWOOD GLEN CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-8914
Country	:	US
Telephone Number	:	702-413-2260
Fax Number	:

Provider Business Practice Location Address
First Line	:	6900 N DURANGO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4409
Country	:	US
Telephone Number	:	702-835-9700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2020
Last Update Date	:	02/10/2026

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