Healthcare Provider Details

I. General information

NPI: 1538496013
Provider Name (Legal Business Name): MICHELLE L GONZALEZ CADC II, ICADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 E 17TH ST UNIT B
SANTA ANA CA
92705-8521
US

IV. Provider business mailing address

603 N CHIPPEWA AVE 210
ANAHEIM CA
92801-4444
US

V. Phone/Fax

Practice location:
  • Phone: 714-542-0400
  • Fax: 714-542-0404
Mailing address:
  • Phone: 323-382-2457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: