Healthcare Provider Details

I. General information

NPI: 1649708561
Provider Name (Legal Business Name): MISS SANDRA MICHELLE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 3RD ST STE 106
NORCO CA
92860-2679
US

IV. Provider business mailing address

3209 FALCON ST
POMONA CA
91767-1007
US

V. Phone/Fax

Practice location:
  • Phone: 626-536-4834
  • Fax:
Mailing address:
  • Phone: 310-890-9830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number3522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: