Healthcare Provider Details

I. General information

NPI: 1275057648
Provider Name (Legal Business Name): ASHLEY ESTALILLA GONZALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 S CENTRAL ST
VISALIA CA
93277-4418
US

IV. Provider business mailing address

PO BOX 697
SPRINGVILLE CA
93265-0697
US

V. Phone/Fax

Practice location:
  • Phone: 559-635-4252
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34507
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: