Healthcare Provider Details

I. General information

NPI: 1770721334
Provider Name (Legal Business Name): SOPHIA GONZALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N 9TH ST STE A
MODESTO CA
95350-5814
US

IV. Provider business mailing address

3416 ALISA CT
MODESTO CA
95356-9440
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-4598
  • Fax: 209-558-4586
Mailing address:
  • Phone: 209-505-0346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC9301214
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: