Individual
MISS JESSICA GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
130 DIVISION ST, DERBY, CT 06418-1326
(203) 732-7252
(203) 732-1539
Mailing address
67 MAPLE AVE, DERBY, CT 06418-1328
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3294
CT
Other
Enumeration date
02/04/2015
Last updated
03/01/2023
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