Provider Demographics
NPI:1093016446
Name:GONZALEZ, BEATRIZ STEPHANIE
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:STEPHANIE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-6012
Mailing Address - Country:US
Mailing Address - Phone:760-482-4044
Mailing Address - Fax:
Practice Address - Street 1:2695 S 4TH ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-6012
Practice Address - Country:US
Practice Address - Phone:760-482-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker