Healthcare Provider Details

I. General information

NPI: 1144823170
Provider Name (Legal Business Name): MARIA A GONZALEZ VALDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FOSTER RD
SANTA MARIA CA
93455-3620
US

IV. Provider business mailing address

PO BOX 1316
SANTA MARIA CA
93456-1316
US

V. Phone/Fax

Practice location:
  • Phone: 805-934-6380
  • Fax: 805-934-6381
Mailing address:
  • Phone: 805-868-1126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: