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Individual

MR. PATRICK JORDAN GONZALES

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
8759 CELEBRATION ST, CHINO, CA 91708-8876
(909) 217-8166
Mailing address
8759 CELEBRATION ST, CHINO, CA 91708-8876
(909) 217-8166

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95015671
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
95015671
NURSE PRACTITIONER FURNISHING NUMNBER
CA
Enumeration date
12/09/2020
Last updated
12/09/2020
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