Healthcare Provider Details

I. General information

NPI: 1487512950
Provider Name (Legal Business Name): MARIELENA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 W METROPOLITAN DR STE 403
ORANGE CA
92868-3504
US

IV. Provider business mailing address

4000 W METROPOLITAN DR STE 403
ORANGE CA
92868-3504
US

V. Phone/Fax

Practice location:
  • Phone: 714-480-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW134868
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: