Healthcare Provider Details

I. General information

NPI: 1952220725
Provider Name (Legal Business Name): IVAN GONZALES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 ECHO HOLLOW RD
EUGENE OR
97402-5899
US

IV. Provider business mailing address

1150 DARLENE LN APT 109
EUGENE OR
97401-1110
US

V. Phone/Fax

Practice location:
  • Phone: 541-607-1430
  • Fax:
Mailing address:
  • Phone: 541-531-9067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: