Healthcare Provider Details

I. General information

NPI: 1104928662
Provider Name (Legal Business Name): MARTHA LETICIA GONZALEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 04/29/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COUNTY OF SANTA CRUZ BEHAVIORAL HEALTH 1430 FREEDOM BLD
WATSONVILLE CA
95076
US

IV. Provider business mailing address

COUNTY OF SANTA CRUZ BEHAVIORAL HEALTH 1430 FREEDOM BLD
WATSONVILLE CA
95076
US

V. Phone/Fax

Practice location:
  • Phone: 831-763-8200
  • Fax:
Mailing address:
  • Phone: 831-763-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number149849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: