Healthcare Provider Details

I. General information

NPI: 1154287563
Provider Name (Legal Business Name): ALEXANDRA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 CAPITOL ST
VALLEJO CA
94590-5721
US

IV. Provider business mailing address

1840 CAPITOL ST
VALLEJO CA
94590-5721
US

V. Phone/Fax

Practice location:
  • Phone: 707-694-6940
  • Fax:
Mailing address:
  • Phone: 707-694-6940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: