Healthcare Provider Details

I. General information

NPI: 1801367081
Provider Name (Legal Business Name): CECILIA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CECILIA ARMENTA

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11846 ELMCROFT AVE
NORWALK CA
90650-7727
US

IV. Provider business mailing address

1040 FLYNN RD
CAMARILLO CA
93012-8705
US

V. Phone/Fax

Practice location:
  • Phone: 562-533-1800
  • Fax:
Mailing address:
  • Phone: 805-673-3930
  • Fax: 805-659-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95030905
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN781707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: