Healthcare Provider Details

I. General information

NPI: 1922620657
Provider Name (Legal Business Name): BETHANIA GONZALEZ FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETHANIA GONZALEZ MENA NP

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 CAMINO MERCADO
ARROYO GRANDE CA
93420-1814
US

IV. Provider business mailing address

536 CAMINO MERCADO
ARROYO GRANDE CA
93420-1814
US

V. Phone/Fax

Practice location:
  • Phone: 833-852-1742
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95013977
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013977
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61497186
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: