Healthcare Provider Details

I. General information

NPI: 1518181940
Provider Name (Legal Business Name): SINDY YESENIA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 S GLENDALE AVE
GLENDALE CA
91205-3204
US

IV. Provider business mailing address

18520 VINCENNES ST APT 25
NORTHRIDGE CA
91324-2931
US

V. Phone/Fax

Practice location:
  • Phone: 818-549-2250
  • Fax:
Mailing address:
  • Phone: 818-359-1112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: