Healthcare Provider Details

I. General information

NPI: 1285300319
Provider Name (Legal Business Name): ANDREA GUADALUPE GONZALEZ APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22942 EL TORO RD
LAKE FOREST CA
92630-4961
US

IV. Provider business mailing address

22942 EL TORO RD
LAKE FOREST CA
92630-4961
US

V. Phone/Fax

Practice location:
  • Phone: 949-683-5131
  • Fax:
Mailing address:
  • Phone: 949-683-5131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number22965
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number13352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: