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NPI Code Detail

MEDICARE: SERGIO GONZALES

MEDICARE: SERGIO GONZALES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1356233423
Entity Type Code : Individual
Provider Name (Legal Business Name) : SERGIO GONZALES
Provider Business Mailing Address
First Line : 1901 E 4TH ST STE 350
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-3908
Country : US
Telephone Number : 888-671-9392
Fax Number :
Provider Business Practice Location Address
First Line : 1901 E 4TH ST STE 350
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-3908
Country : US
Telephone Number : 888-671-9392
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2025
Last Update Date : 07/15/2025

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Directions to “ SERGIO GONZALES ” Practice Location

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