Healthcare Provider Details

I. General information

NPI: 1427886837
Provider Name (Legal Business Name): YASMINE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

672 W 11TH ST
TRACY CA
95376-3821
US

IV. Provider business mailing address

322 CULVER BLVD # 1121
PLAYA DEL REY CA
90293-7704
US

V. Phone/Fax

Practice location:
  • Phone: 209-318-0760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number157627
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20835
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: