Provider Demographics
NPI:1538244538
Name:GONZALEZ, JOSE JOAQUIN (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:JOAQUIN
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:625 FAIR OAKS AVE
Mailing Address - Street 2:SUITE 390
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2630
Mailing Address - Country:US
Mailing Address - Phone:800-314-7273
Mailing Address - Fax:800-307-9438
Practice Address - Street 1:625 FAIR OAKS AVE
Practice Address - Street 2:SUITE 390
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2630
Practice Address - Country:US
Practice Address - Phone:800-314-7273
Practice Address - Fax:800-307-9438
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY 15161103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist