Healthcare Provider Details

I. General information

NPI: 1962924092
Provider Name (Legal Business Name): PAULA REBECCA GONSALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULA REBECCA GONZALEZ

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10417 MAIN ST
LAMONT CA
93241-1726
US

IV. Provider business mailing address

7839 BURGUNDY AVE
LAMONT CA
93241-1338
US

V. Phone/Fax

Practice location:
  • Phone: 661-845-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number108488
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number108488
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: