MEDICARE: JENNIFER CASSANDRA GONZALEZ

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	251E00000X	Home Health Agency
4	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1659137974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER CASSANDRA GONZALEZ

Provider Business Mailing Address
First Line	:	3908 TOUCAN AVE
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-5964
Country	:	US
Telephone Number	:	956-984-8569
Fax Number	:

Provider Business Practice Location Address
First Line	:	4716 BUDDY OWENS AVE
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-4807
Country	:	US
Telephone Number	:	956-534-6148
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER CASSANDRA GONZALEZ
Credential	:
Telephone Number	:	956-984-8569

Provider Enumeration Date	:	02/23/2024
Last Update Date	:	05/16/2024

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