Healthcare Provider Details

I. General information

NPI: 1720391618
Provider Name (Legal Business Name): AMALIA GONZALEZ ROSALES MA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMALIA JASMIN GONZALEZ MA CCC-SLP

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

662 HAZEL DELL RD
CORRALITOS CA
95076-0313
US

IV. Provider business mailing address

760 C ST
HOLLISTER CA
95023
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-2585
  • Fax:
Mailing address:
  • Phone: 559-304-0664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number13360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: