Active NPI
John Carlos Gonzales
- Peer Specialist
- Cottonwood Heights, UT
National Provider Identifier
1699278366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- Practice address
- 7873 S Chadbourne Dr
Cottonwood Heights, UT 84121-5806 - Phone
- (801) 244-3280
- NPI assigned
- Mar 8, 2018
- 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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | Primary |
Addresses
Primary practice location
7873 S Chadbourne Dr
Cottonwood Heights, UT 84121-5806
Mailing address
7873 S Chadbourne Dr
Cottonwood Heights, UT 84121-5806
Phone (801) 244-3280
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R58639857 | Other | OR | BLUE CROSS BLUE SHIELD |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1520467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1520467200000",
"number": "1699278366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7873 S CHADBOURNE DR",
"city": "COTTONWOOD HEIGHTS",
"state": "UT",
"postal_code": "841215806",
"telephone_number": "801-244-3280"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7873 S CHADBOURNE DR",
"city": "COTTONWOOD HEIGHTS",
"state": "UT",
"postal_code": "841215806",
"telephone_number": "801-244-3280"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALES",
"first_name": "JOHN",
"middle_name": "CARLOS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-03-08",
"last_updated": "2018-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "R58639857",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cottonwood Heights, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.