Provider Demographics
NPI:1669355699
Name:LANDAVERDE, JENNIFER GONZALEZ
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GONZALEZ
Last Name:LANDAVERDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8989 STATE HIGHWAY 110
Mailing Address - Street 2:
Mailing Address - City:GRAND SALINE
Mailing Address - State:TX
Mailing Address - Zip Code:75140-5358
Mailing Address - Country:US
Mailing Address - Phone:903-526-9654
Mailing Address - Fax:
Practice Address - Street 1:12 UPPER RAGSDALE DR
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5730
Practice Address - Country:US
Practice Address - Phone:831-648-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27940225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist