Healthcare Provider Details

I. General information

NPI: 1366803397
Provider Name (Legal Business Name): BELEN GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 E GUASTI RD STE 100
ONTARIO CA
91761-8661
US

IV. Provider business mailing address

24878 MANZANITA AVE
MORENO VALLEY CA
92557-4208
US

V. Phone/Fax

Practice location:
  • Phone: 213-770-3268
  • Fax:
Mailing address:
  • Phone: 562-285-8180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number94858
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: