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General NPI Number Information
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NPI Number | 1043400591
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Entity Type | Individual
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Provider Name | HENRY A. GONZALEZ RAS
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Gender | Male
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Dates
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Enumeration Date | 07/31/2007
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Last Update Date | 01/15/2019
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Provider Practice Location Address
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Address Line | 1021 W LA CADENA DR
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City | RIVERSIDE
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State | CA
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Zip | 92501-1413
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Country | US
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Telephone | 951-784-8010
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Fax | 951-784-2859
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Provider Business Mailing Address
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Address Line | 735 N D ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92401-1111
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Country | US
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Telephone | 909-381-5507
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Fax | 909-888-5938
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | GO412291733
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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