Healthcare Provider Details

I. General information

NPI: 1104748474
Provider Name (Legal Business Name): SARAH ROSE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 SCHOLAR WAY
EASTVALE CA
92880-4019
US

IV. Provider business mailing address

6969 CANOSA PL
RANCHO CUCAMONGA CA
91701-8506
US

V. Phone/Fax

Practice location:
  • Phone: 909-238-1667
  • Fax:
Mailing address:
  • Phone: 909-238-1667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number240152077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: