Healthcare Provider Details

I. General information

NPI: 1497623375
Provider Name (Legal Business Name): KATHERINE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12450 VAN NUYS BLVD
PACOIMA CA
91331-1391
US

IV. Provider business mailing address

100 N PACIFIC COAST HWY STE 1400
EL SEGUNDO CA
90245-5602
US

V. Phone/Fax

Practice location:
  • Phone: 818-896-1161
  • Fax:
Mailing address:
  • Phone: 310-856-0800
  • Fax: 855-568-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: