MEDICARE: IRENE FRANCES GONZALES RAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1528662525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE FRANCES GONZALES RAC

Provider Business Mailing Address
First Line	:	201 D ST
Second Line	:
City	:	MARYSVILLE
State	:	CA
Zip	:	95901-5952
Country	:	US
Telephone Number	:	530-742-7747
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 D ST
Second Line	:
City	:	MARYSVILLE
State	:	CA
Zip	:	95901-5952
Country	:	US
Telephone Number	:	530-237-1715
Fax Number	:	530-742-7642

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

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	07/11/2024

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