Healthcare Provider Details

I. General information

NPI: 1992426480
Provider Name (Legal Business Name): EMANUEL GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 10/19/2026
Certification Date: 10/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 RICHLAND AVE
CERES CA
95307-4562
US

IV. Provider business mailing address

1904 RICHLAND AVE
CERES CA
95307-4562
US

V. Phone/Fax

Practice location:
  • Phone: 209-300-8800
  • Fax: 209-300-8898
Mailing address:
  • Phone: 209-300-8800
  • Fax: 209-300-8898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: