Healthcare Provider Details

I. General information

NPI: 1285254961
Provider Name (Legal Business Name): MARITZA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date: 08/19/2025
Reactivation Date: 12/08/2025

III. Provider practice location address

268 LEWELLING BLVD
ASHLAND CA
94580-1632
US

IV. Provider business mailing address

25 RIO ROBLES E UNIT 128
SAN JOSE CA
95134-1663
US

V. Phone/Fax

Practice location:
  • Phone: 510-930-9233
  • Fax:
Mailing address:
  • Phone: 510-944-7487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number748208
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: