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1891489001
JORGE ANTONIO GONZALES MEDINA
RIVERSIDE, CA
NPI
1891489001
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
106S00000X Behavior Technician
Enumeration Date
2023-06-08
Last Update Date
2023-06-08
Business Address
JORGE ANTONIO GONZALES MEDINA
3600 LIME ST STE 521
RIVERSIDE, CA 92501-0918
Phone number: 909-767-8327
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Mailing Address
JORGE ANTONIO GONZALES MEDINA
200 E 30TH ST APT 24
SAN BERNARDINO, CA 92404-2338
Phone number: 909-379-5765
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