Healthcare Provider Details

I. General information

NPI: 1427849108
Provider Name (Legal Business Name): KIMBERLY PAIGE BROOKS-GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20302 FLANAGAN ROAD
TRABUCO CANYON CA
92679
US

IV. Provider business mailing address

14530 SYLVAN ST
VAN NUYS CA
91411-2324
US

V. Phone/Fax

Practice location:
  • Phone: 818-582-8832
  • Fax: 818-582-8836
Mailing address:
  • Phone: 818-582-8832
  • Fax: 818-582-8836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-NUHESA
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1423821225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: