Healthcare Provider Details

I. General information

NPI: 1407570617
Provider Name (Legal Business Name): DIANA GONZALEZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 5TH ST STE 590
SANTA ANA CA
92701-4599
US

IV. Provider business mailing address

405 W 5TH ST STE 590
SANTA ANA CA
92701-4599
US

V. Phone/Fax

Practice location:
  • Phone: 714-935-6065
  • Fax: 323-242-5000
Mailing address:
  • Phone: 714-935-6065
  • Fax: 323-242-5000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number107609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: