Individual
JOHN CARLOS GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7873 S CHADBOURNE DR, COTTONWOOD HEIGHTS, UT 84121-5806
(801) 244-3280
Mailing address
7873 S CHADBOURNE DR, COTTONWOOD HEIGHTS, UT 84121-5806
(801) 244-3280
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R58639857
BLUE CROSS BLUE SHIELD
OR
Enumeration date
03/08/2018
Last updated
03/08/2018
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