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NPI Code Detail

MEDICARE: DR. MARLENE M. GONZALEZ PHD

MEDICARE: DR. MARLENE M. GONZALEZ PHD
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
1103TC0700XClinical PsychologistPSY30636CA

General Provider Information

NPI Number : 1194126615
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARLENE M. GONZALEZ PHD
Provider Business Mailing Address
First Line : 23461 S POINTE DR STE 220
Second Line :
City : LAGUNA HILLS
State : CA
Zip : 92653-1523
Country : US
Telephone Number : 949-855-1556
Fax Number :
Provider Business Practice Location Address
First Line : 23461 S POINTE DR STE 220
Second Line :
City : LAGUNA HILLS
State : CA
Zip : 92653-1523
Country : US
Telephone Number : 949-855-1556
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2014
Last Update Date : 01/27/2026

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