Provider Demographics
NPI:1336025964
Name:GONZALEZ, JESSICA-CARINA
Entity type:Individual
Prefix:
First Name:JESSICA-CARINA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81-980 HALEKII ST STE 107
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-8177
Mailing Address - Country:US
Mailing Address - Phone:808-934-3253
Mailing Address - Fax:808-934-3253
Practice Address - Street 1:81-980 HALEKII ST STE 107
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-8177
Practice Address - Country:US
Practice Address - Phone:808-934-3253
Practice Address - Fax:808-934-3253
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator