Individual
JOSE LUIS GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CO,BOCO
Contact information
Practice address
12075 CORPORATE PKWY STE 120, MEQUON, WI 53092-2664
(262) 643-4418
Mailing address
20225 SUTTER CREEK DR APT 208, BROOKFIELD, WI 53045-3931
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
—
—
Other
Enumeration date
11/09/2018
Last updated
11/09/2018
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