Healthcare Provider Details

I. General information

NPI: 1689543167
Provider Name (Legal Business Name): CRISTA GONZALEZ EDUCATIONAL PSYCHOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S CATALINA AVE STE 118
REDONDO BEACH CA
90277-3388
US

IV. Provider business mailing address

5110 PATRICK ST
TORRANCE CA
90503-1931
US

V. Phone/Fax

Practice location:
  • Phone: 310-367-2368
  • Fax:
Mailing address:
  • Phone: 310-367-2368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. CRISTA GONZALEZ
Title or Position: LICENSED EDUCATIONAL PSYCHOLOGIST
Credential: LEP
Phone: 310-367-2368