Healthcare Provider Details

I. General information

NPI: 1275180010
Provider Name (Legal Business Name): CYNTHIA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43807 10TH ST W STE A
LANCASTER CA
93534-4805
US

IV. Provider business mailing address

PO BOX 2301
LANCASTER CA
93539-2301
US

V. Phone/Fax

Practice location:
  • Phone: 661-727-0662
  • Fax: 661-418-0060
Mailing address:
  • Phone: 661-727-0662
  • Fax: 661-481-0060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16094
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: