Healthcare Provider Details

I. General information

NPI: 1861147597
Provider Name (Legal Business Name): MR. ARMANDO L GONZALES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 E 1ST ST
SANTA ANA CA
92705-4007
US

IV. Provider business mailing address

1422 WALLING AVE
BREA CA
92821-2438
US

V. Phone/Fax

Practice location:
  • Phone: 951-536-0178
  • Fax:
Mailing address:
  • Phone: 714-561-2970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: