Healthcare Provider Details

I. General information

NPI: 1528650587
Provider Name (Legal Business Name): MARIA PAULINA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 CARDINAL LN
SAN DIEGO CA
92123-3743
US

IV. Provider business mailing address

4550 OHIO ST
SAN DIEGO CA
92116-4345
US

V. Phone/Fax

Practice location:
  • Phone: 619-395-9792
  • Fax:
Mailing address:
  • Phone: 619-395-9792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number612A9726D6
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: