Healthcare Provider Details

I. General information

NPI: 1033560487
Provider Name (Legal Business Name): RUBEN DIEGO GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 S SUNWEST LN SUITE 200
SAN BERNARDINO CA
92408-3258
US

IV. Provider business mailing address

1950 S SUNWEST LN SUITE 200
SAN BERNARDINO CA
92408-3258
US

V. Phone/Fax

Practice location:
  • Phone: 909-252-4010
  • Fax: 909-252-4055
Mailing address:
  • Phone: 909-252-4010
  • Fax: 909-252-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number122139
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: