Healthcare Provider Details

I. General information

NPI: 1467975987
Provider Name (Legal Business Name): VICTORIA MERCEDES GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 E SANTA CLARA ST
SAN JOSE CA
95116-2337
US

IV. Provider business mailing address

777 N 1ST ST STE 444
SAN JOSE CA
95112-6339
US

V. Phone/Fax

Practice location:
  • Phone: 408-240-0070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number126848
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: