Healthcare Provider Details

I. General information

NPI: 1356955207
Provider Name (Legal Business Name): VANESSA LEANETE GONZALEZ GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VANESSA LEANETE GONZALEZ

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 INLAND EMPIRE BLVD
ONTARIO CA
91764-4898
US

IV. Provider business mailing address

2940 INLAND EMPIRE BLVD
ONTARIO CA
91764-4898
US

V. Phone/Fax

Practice location:
  • Phone: 909-458-1350
  • Fax:
Mailing address:
  • Phone: 909-458-1350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number127676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: