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General NPI Number Information
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NPI Number | 1831720952
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Entity Type | Individual
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Provider Name | STEPHANIE ANDREA GONZALES B.S.
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Gender | Female
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Dates
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Enumeration Date | 01/28/2020
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 7062 NAPA AVE
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City | ALTA LOMA
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State | CA
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Zip | 91701-5431
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Country | US
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Telephone | 909-773-8597
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Fax |
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Provider Business Mailing Address
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Address Line | 8780 19TH ST STE 1996
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City | ALTA LOMA
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State | CA
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Zip | 91701-4608
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Country | US
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Telephone | 909-773-8597
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 114660
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 114660
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License Number State | CA
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