Healthcare Provider Details

I. General information

NPI: 1477225191
Provider Name (Legal Business Name): BRENNA RENEE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36101 EXPLORER DR APT 11201
PALM DESERT CA
92211-2244
US

IV. Provider business mailing address

36101 EXPLORER DR APT 11201
PALM DESERT CA
92211-2244
US

V. Phone/Fax

Practice location:
  • Phone: 760-459-9794
  • Fax:
Mailing address:
  • Phone: 760-459-9794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: