Active NPI
Jacob Benjamin Gonzalez, L.M.T.
- Massage Therapist
- Lake Havasu City, AZ
National Provider Identifier
1417247172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT-13311
- Practice address
- 133 Saguaro Dr
Lake Havasu City, AZ 86403-6657 - Phone
- (928) 846-7845
- NPI assigned
- Apr 15, 2011
- Last updated
- Apr 15, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MT-13311 | AZ | Primary |
Addresses
Primary practice location
133 Saguaro Dr
Lake Havasu City, AZ 86403-6657
Mailing address
133 Saguaro Dr
Lake Havasu City, AZ 86403-6657
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT-13311 | AZ | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302825600000",
"number": "1417247172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "133 SAGUARO DR",
"city": "LAKE HAVASU CITY",
"state": "AZ",
"postal_code": "864036657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "133 SAGUARO DR",
"city": "LAKE HAVASU CITY",
"state": "AZ",
"postal_code": "864036657",
"telephone_number": "928-846-7845"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALEZ",
"first_name": "JACOB",
"middle_name": "BENJAMIN",
"credential": "L.M.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-04-15",
"last_updated": "2011-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "AZ",
"license": "MT-13311",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Havasu City, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.