Healthcare Provider Details

I. General information

NPI: 1275357394
Provider Name (Legal Business Name): CINDY GONZALEZ PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39600 LOGAN DR
FREMONT CA
94538-1912
US

IV. Provider business mailing address

39600 LOGAN DR
FREMONT CA
94538-1912
US

V. Phone/Fax

Practice location:
  • Phone: 510-656-7211
  • Fax:
Mailing address:
  • Phone: 510-656-7211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number200012772
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: