MEDICARE: JENNIFER MARIE GONZALES NP

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	163WI0500X	Infusion Therapy Registered Nurse	95021431	CA

General Provider Information

NPI Number	:	1578336459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARIE GONZALES NP

Provider Business Mailing Address
First Line	:	54949 MOUNTAIN VIEW TRL
Second Line	:
City	:	YUCCA VALLEY
State	:	CA
Zip	:	92284-4628
Country	:	US
Telephone Number	:	951-520-6158
Fax Number	:

Provider Business Practice Location Address
First Line	:	1276 N PALM CANYON DR STE 205B
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4430
Country	:	US
Telephone Number	:	951-520-6158
Fax Number	:

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

Provider Enumeration Date	:	11/02/2023
Last Update Date	:	11/02/2023

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