Healthcare Provider Details

I. General information

NPI: 1700709383
Provider Name (Legal Business Name): WENDY LISSETH GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 PENINSULA AVE
SAN MATEO CA
94401-1653
US

IV. Provider business mailing address

17 BUTLER RD
SOUTH SAN FRANCISCO CA
94080-1708
US

V. Phone/Fax

Practice location:
  • Phone: 650-286-4396
  • Fax: 650-286-4396
Mailing address:
  • Phone: 571-245-9861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: