Healthcare Provider Details

I. General information

NPI: 1801102850
Provider Name (Legal Business Name): LEANN MARGARET GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEANN MARGARET GONZALEZ JIMENEZ

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E REDLANDS BLVD STE 234D
REDLANDS CA
92373-4775
US

IV. Provider business mailing address

101 E REDLANDS BLVD STE 234D
REDLANDS CA
92373-4775
US

V. Phone/Fax

Practice location:
  • Phone: 951-807-0367
  • Fax:
Mailing address:
  • Phone: 909-989-4055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number109047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: