Healthcare Provider Details

I. General information

NPI: 1275843542
Provider Name (Legal Business Name): CHRISTINA GONERKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 06/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19000 HOMESTEAD RD
CUPERTINO CA
95014-0712
US

IV. Provider business mailing address

P.O. BOX 2824
REDWOOD CITY CA
94064
US

V. Phone/Fax

Practice location:
  • Phone: 408-851-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW74444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: