Healthcare Provider Details

I. General information

NPI: 1144920844
Provider Name (Legal Business Name): IZACARINA GONZALES MORENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 ARNOLD DR STE 200
MARTINEZ CA
94553-4189
US

IV. Provider business mailing address

1340 ARNOLD DR STE 200
MARTINEZ CA
94553-4189
US

V. Phone/Fax

Practice location:
  • Phone: 925-957-5150
  • Fax:
Mailing address:
  • Phone: 925-957-5150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: