Healthcare Provider Details

I. General information

NPI: 1548403322
Provider Name (Legal Business Name): VIRGINIA DOLORES ESCOTO-GONZALEZ LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 CENTRE LAKE DR
ONTARIO CA
91761-1211
US

IV. Provider business mailing address

1484 CLAREMONT PL
POMONA CA
91767-4126
US

V. Phone/Fax

Practice location:
  • Phone: 866-205-3595
  • Fax:
Mailing address:
  • Phone: 909-973-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: