MEDICARE: DOLORES GONZALEZ

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	103TS0200X	School Psychologist		CA

General Provider Information

NPI Number	:	1164354288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOLORES GONZALEZ

Provider Business Mailing Address
First Line	:	41852 MARWOOD CIR
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92591-1872
Country	:	US
Telephone Number	:	760-443-4151
Fax Number	:

Provider Business Practice Location Address
First Line	:	2221 S A ST
Second Line	:
City	:	PERRIS
State	:	CA
Zip	:	92570-9318
Country	:	US
Telephone Number	:	951-940-4942
Fax Number	:

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

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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Directions to “ DOLORES GONZALEZ ” Practice Location

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