Healthcare Provider Details

I. General information

NPI: 1164354288
Provider Name (Legal Business Name): DOLORES GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 S A ST
PERRIS CA
92570-9318
US

IV. Provider business mailing address

41852 MARWOOD CIR
TEMECULA CA
92591-1872
US

V. Phone/Fax

Practice location:
  • Phone: 951-940-4942
  • Fax:
Mailing address:
  • Phone: 760-443-4151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: