Healthcare Provider Details

I. General information

NPI: 1659987311
Provider Name (Legal Business Name): CAROLINE GONZALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 EUCLID AVE STE 225
SAN DIEGO CA
92114-3629
US

IV. Provider business mailing address

292 EUCLID AVE STE 225
SAN DIEGO CA
92114-3629
US

V. Phone/Fax

Practice location:
  • Phone: 858-392-6313
  • Fax:
Mailing address:
  • Phone: 858-392-6313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: