Healthcare Provider Details

I. General information

NPI: 1003190281
Provider Name (Legal Business Name): SANDRA GONZALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E VIRGINIA ST SUITE 280
SAN JOSE CA
95112-5857
US

IV. Provider business mailing address

160 E VIRGINIA ST SUITE 280
SAN JOSE CA
95112-5857
US

V. Phone/Fax

Practice location:
  • Phone: 408-287-6200
  • Fax: 408-998-1535
Mailing address:
  • Phone: 408-287-6200
  • Fax: 408-998-1535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: