Healthcare Provider Details

I. General information

NPI: 1407702418
Provider Name (Legal Business Name): CRYSTAL MARIE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S FREMONT AVE BLDG A10 SUITE 10100
ALHAMBRA CA
91803-8800
US

IV. Provider business mailing address

15003 FOLGER ST
HACIENDA HEIGHTS CA
91745-2016
US

V. Phone/Fax

Practice location:
  • Phone: 626-349-3838
  • Fax:
Mailing address:
  • Phone: 626-349-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: