Individual
CANDELARIO GONZALEZ JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
311 1ST ST N, NAMPA, ID 83687-3396
(208) 353-0189
Mailing address
PO BOX 695, NAMPA, ID 83653-0695
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
12/23/2014
Last updated
12/31/2014
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