Individual
MR. RAYMOND LEE GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CMA-I, CNA, HHA,DDCA
Contact information
Practice address
1623 S 128TH EAST AVE, TULSA, OK 74128-6025
(918) 437-8156
Mailing address
1623 S 128TH EAST AVE, TULSA, OK 74128-6025
(918) 437-8156
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
37V840760399
OK
372600000X
Adult Companion
37V840760399
OK
373H00000X
Day Training/Habilitation Specialist
Primary
320178900107
OK
376J00000X
Homemaker
37V840760399
OK
376K00000X
Nurse's Aide
37V615640107
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
544235569A
MEDICARE OKLAHOMA CLAIM NUMBER FOR JEFFREY ROSE
OK
Enumeration date
01/06/2010
Last updated
01/06/2010
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