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NPI Code Detail

MEDICARE: BRANDIS LYNN GONZALES

MEDICARE: BRANDIS LYNN 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
1106S00000XBehavior Technician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790285393
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDIS LYNN GONZALES
Provider Business Mailing Address
First Line : 21600 OXNARD ST STE 1800
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-7807
Country : US
Telephone Number : 818-345-2345
Fax Number :
Provider Business Practice Location Address
First Line : 6030 W OAKS BLVD STE 170
Second Line :
City : ROCKLIN
State : CA
Zip : 95765-4437
Country : US
Telephone Number : 916-824-3220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2018
Last Update Date : 05/23/2022

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