Provider Demographics
NPI:1093423816
Name:GONZALEZ, JOSHUA
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 N BATAVIA ST STE 104
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-3526
Mailing Address - Country:US
Mailing Address - Phone:657-456-8558
Mailing Address - Fax:833-256-3911
Practice Address - Street 1:1411 N BATAVIA ST STE 104
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-3526
Practice Address - Country:US
Practice Address - Phone:657-456-8558
Practice Address - Fax:833-256-3911
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator