Healthcare Provider Details

I. General information

NPI: 1861822504
Provider Name (Legal Business Name): JUNIOR GONZALEZ MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KINGS WAY
AVENAL CA
93204-9708
US

IV. Provider business mailing address

2187 W BERKSHIRE LN
HANFORD CA
93230-9163
US

V. Phone/Fax

Practice location:
  • Phone: 559-386-0587
  • Fax:
Mailing address:
  • Phone: 559-309-5664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW76909
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: