Individual
JESSICA GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1202 S TYLER ST, COVINGTON, LA 70433-2330
(985) 898-4194
(985) 898-4164
Mailing address
PO BOX 54482, NEW ORLEANS, LA 70154-4482
(985) 898-4451
(985) 898-4358
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD.204732
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06880542
—
MS
05
—
2162659
—
LA
Enumeration date
07/18/2011
Last updated
08/09/2022
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