MEDICARE: SHARENNE EMMANUELLA GOZAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	159848	CA

General Provider Information

NPI Number	:	1104499714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARENNE EMMANUELLA GOZAL

Provider Business Mailing Address
First Line	:	490 N GRAPE ST
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-3079
Country	:	US
Telephone Number	:	760-975-9939
Fax Number	:

Provider Business Practice Location Address
First Line	:	2308 CRYSTAL POINTE
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-6240
Country	:	US
Telephone Number	:	626-560-0612
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2021
Last Update Date	:	06/16/2026

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