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General NPI Number Information
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NPI Number | 1437398336
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Entity Type | Individual
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Provider Name | TANIA MARIE GONZALEZ PH.D.
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Gender | Female
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Dates
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Enumeration Date | 02/17/2009
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Last Update Date | 07/25/2016
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Provider Practice Location Address
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Address Line | 312 W J ST STE 201
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City | LOS BANOS
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State | CA
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Zip | 93635-4073
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Country | US
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Telephone | 209-826-4870
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Fax |
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Provider Business Mailing Address
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Address Line | 1350 'E' PACHECO BLVD PMB #122
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City | LOS BANOS
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State | CA
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Zip | 93635-4946
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Country | US
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Telephone | 209-631-0373
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Fax | 209-722-7210
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY20834
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License Number State | CA
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