Healthcare Provider Details

I. General information

NPI: 1184000689
Provider Name (Legal Business Name): CRISTINA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date: 06/04/2019
Reactivation Date: 08/07/2019

III. Provider practice location address

1756 S LEWIS RD
CAMARILLO CA
93012-8520
US

IV. Provider business mailing address

1756 S LEWIS RD
CAMARILLO CA
93012-8520
US

V. Phone/Fax

Practice location:
  • Phone: 805-437-2903
  • Fax:
Mailing address:
  • Phone: 805-383-3669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW90189
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: