Healthcare Provider Details

I. General information

NPI: 1609714260
Provider Name (Legal Business Name): JULIE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 TEMESCAL CANYON RD
CORONA CA
92883-4625
US

IV. Provider business mailing address

10141 MEDALLION PL
RIVERSIDE CA
92503-1034
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-1223
  • Fax:
Mailing address:
  • Phone: 951-522-0475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW134224
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: