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General NPI Number Information
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NPI Number | 1740692722
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Entity Type | Individual
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Provider Name | VIVIANA GONZALEZ BA
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Gender | Female
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Dates
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Enumeration Date | 05/27/2014
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Last Update Date | 03/03/2017
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Provider Practice Location Address
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Address Line | 2535 KETTNER AVE 1A4
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City | SAN DIEGO
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State | CALIFORNIA
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Zip | 92101
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Country | UM
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Telephone | 619-615-0701
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Fax |
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Provider Business Mailing Address
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Address Line | 640 OAKLAWN AVE
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City | CHULA VISTA
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State | CA
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Zip | 91910-5217
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Country | US
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Telephone | 626-353-4950
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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