Active NPI
Jordan Anthony Gonzales, LMFT, ATR-P
- Marriage & Family Therapist
- Redwood City, CA
National Provider Identifier
1174017677
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- Practice address
- 400 Edmonds Rd
Redwood City, CA 94062-3803 - Phone
- (650) 839-1810
- NPI assigned
- Jun 18, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | Primary |
Addresses
Primary practice location
400 Edmonds Rd
Redwood City, CA 94062-3803
Mailing address
20353 Park Way Apt 44
Castro Valley, CA 94546-5324
Phone (916) 215-8068
Other practice location 1
225 37th Ave Fl 3
San Mateo, CA 94403-4324
Phone (650) 363-4000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615939200000",
"number": "1174017677",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20353 PARK WAY APT 44",
"city": "CASTRO VALLEY",
"state": "CA",
"postal_code": "945465324",
"telephone_number": "916-215-8068"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 EDMONDS RD",
"city": "REDWOOD CITY",
"state": "CA",
"postal_code": "940623803",
"telephone_number": "650-839-1810"
}
],
"practiceLocations": [
{
"address_1": "225 37th Ave Fl 3",
"address_purpose": "LOCATION",
"city": "San Mateo",
"state": "CA",
"postal_code": "944034324",
"country_code": "US",
"telephone_number": "650-363-4000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GONZALES",
"first_name": "JORDAN",
"middle_name": "ANTHONY",
"credential": "LMFT, ATR-P",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-18",
"last_updated": "2021-03-17",
"certification_date": "2021-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redwood City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.