Healthcare Provider Details

I. General information

NPI: 1275991705
Provider Name (Legal Business Name): MRS. JODI GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 PEACH DR
SALINAS CA
93901-3710
US

IV. Provider business mailing address

769 ARCHER ST APT 9
SALINAS CA
93901-1354
US

V. Phone/Fax

Practice location:
  • Phone: 831-753-5135
  • Fax:
Mailing address:
  • Phone: 831-269-9670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number7011-R
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: