Individual
EZEKIEL GONZALEZ-FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1921 PETIT BOIS ST N, JACKSON, MS 39211-6708
(716) 348-6067
Mailing address
1921 PETIT BOIS ST N, JACKSON, MS 39211-6708
(716) 348-6067
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/12/2022
Last updated
04/12/2022
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