Healthcare Provider Details

I. General information

NPI: 1457813081
Provider Name (Legal Business Name): JENNIFER GONZALEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR STE 150
OXNARD CA
93036-2612
US

IV. Provider business mailing address

900 LARKSPUR LANDING CIR STE 285
LARKSPUR CA
94939-1765
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-8460
  • Fax: 805-981-8461
Mailing address:
  • Phone: 707-258-8757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA194039
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD210593
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: