Healthcare Provider Details

I. General information

NPI: 1609401488
Provider Name (Legal Business Name): DENNIS GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 MCHENRY AVE
MODESTO CA
95350-1451
US

IV. Provider business mailing address

3125 MCHENRY AVE
MODESTO CA
95350-1451
US

V. Phone/Fax

Practice location:
  • Phone: 209-523-6910
  • Fax: 209-523-6912
Mailing address:
  • Phone: 209-523-6910
  • Fax: 209-491-0627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: