Healthcare Provider Details

I. General information

NPI: 1477954394
Provider Name (Legal Business Name): MATTHEW PAUL GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 W MINERAL KING AVE STE A
VISALIA CA
93291-5605
US

IV. Provider business mailing address

3400 W MINERAL KING AVE STE A
VISALIA CA
93291-5605
US

V. Phone/Fax

Practice location:
  • Phone: 559-627-2046
  • Fax:
Mailing address:
  • Phone: 559-627-2046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number73494
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number156560
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number109777
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: