Healthcare Provider Details

I. General information

NPI: 1215766514
Provider Name (Legal Business Name): DENISSE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 WHISTLER WAY
STOCKTON CA
95209-4157
US

IV. Provider business mailing address

1305 E VINE ST
LODI CA
95240-3179
US

V. Phone/Fax

Practice location:
  • Phone: 209-953-8106
  • Fax: 209-953-8110
Mailing address:
  • Phone: 209-331-7000
  • Fax: 209-331-7256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number240190104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: