MEDICARE: TERESA GONZALEZ

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
1	106H00000X	Marriage & Family Therapist	93447	CA

General Provider Information

NPI Number	:	1881144327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA GONZALEZ

Provider Business Mailing Address
First Line	:	934 PIEDMONT ST
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93035-1538
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 OUTLET CENTER DR STE 430
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93036-0611
Country	:	US
Telephone Number	:	805-278-0799
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2016
Last Update Date	:	10/07/2016

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Directions to “ TERESA GONZALEZ ” Practice Location

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