Healthcare Provider Details

I. General information

NPI: 1124332648
Provider Name (Legal Business Name): CLAUDIA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31180 ROAD 72
VISALIA CA
93291-9672
US

IV. Provider business mailing address

305 E CENTER AVE
VISALIA CA
93291-6331
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number28286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: