Individual
JACOB BENJAMIN GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.M.T.
Contact information
Practice address
133 SAGUARO DR, LAKE HAVASU CITY, AZ 86403-6657
(928) 846-7845
Mailing address
133 SAGUARO DR, LAKE HAVASU CITY, AZ 86403-6657
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT-13311
AZ
Other
Enumeration date
04/15/2011
Last updated
04/15/2011
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