Healthcare Provider Details

I. General information

NPI: 1295550846
Provider Name (Legal Business Name): MARIANA GONZALEZ LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4357 THORNTON AVE
FREMONT CA
94536-4827
US

IV. Provider business mailing address

232 DELL CT
HAYWARD CA
94541-3701
US

V. Phone/Fax

Practice location:
  • Phone: 510-793-9090
  • Fax:
Mailing address:
  • Phone: 510-258-9813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number240091681
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: