Healthcare Provider Details

I. General information

NPI: 1205229705
Provider Name (Legal Business Name): MRS. NICOLE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6428 EASTER LILY CT
BAKERSFIELD CA
93313-6008
US

IV. Provider business mailing address

6428 EASTER LILY CT
BAKERSFIELD CA
93313-6008
US

V. Phone/Fax

Practice location:
  • Phone: 661-832-8402
  • Fax:
Mailing address:
  • Phone: 661-397-8775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF84844
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: