Healthcare Provider Details

I. General information

NPI: 1831720952
Provider Name (Legal Business Name): STEPHANIE ANDREA GONZALES B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7062 NAPA AVE
ALTA LOMA CA
91701-5431
US

IV. Provider business mailing address

8780 19TH ST STE 1996
ALTA LOMA CA
91701-4608
US

V. Phone/Fax

Practice location:
  • Phone: 909-773-8597
  • Fax:
Mailing address:
  • Phone: 909-773-8597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number114660
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: