Healthcare Provider Details

I. General information

NPI: 1790601847
Provider Name (Legal Business Name): DR. BRENDA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 ARENA BLVD
SACRAMENTO CA
95834-3003
US

IV. Provider business mailing address

1744 MAPLETON DR
DALLAS TX
75228-4236
US

V. Phone/Fax

Practice location:
  • Phone: 916-574-9400
  • Fax:
Mailing address:
  • Phone: 469-234-0018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: