Healthcare Provider Details

I. General information

NPI: 1700096807
Provider Name (Legal Business Name): MISS VERONICA L GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 OLIVE AVENUE STE 100
REDLANDS CA
92373
US

IV. Provider business mailing address

1752 E LUGONIA AVE. STE 117 PMB #213
REDLANDS CA
92374-2730
US

V. Phone/Fax

Practice location:
  • Phone: 951-394-3191
  • Fax:
Mailing address:
  • Phone: 951-394-3191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT130279
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: