Provider Demographics
NPI:1538045844
Name:GONZALES, ANDREW JORDAN
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JORDAN
Last Name:GONZALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 E HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-2156
Mailing Address - Country:US
Mailing Address - Phone:724-510-8460
Mailing Address - Fax:
Practice Address - Street 1:224 E HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-2156
Practice Address - Country:US
Practice Address - Phone:724-510-8460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program