Healthcare Provider Details

I. General information

NPI: 1851174692
Provider Name (Legal Business Name): ALONDRA GUADALUPE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 BERNAL RD
SAN JOSE CA
95119-1809
US

IV. Provider business mailing address

1558 MOUNT FRAZIER DR
SAN JOSE CA
95127-4854
US

V. Phone/Fax

Practice location:
  • Phone: 408-638-4744
  • Fax: 408-956-6303
Mailing address:
  • Phone: 408-830-6135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: