Provider Demographics
NPI:1154820439
Name:GONZALEZ-DOUPE, PILAR ANTONIA (PHD, MSC)
Entity Type:Individual
Prefix:DR
First Name:PILAR
Middle Name:ANTONIA
Last Name:GONZALEZ-DOUPE
Suffix:
Gender:F
Credentials:PHD, MSC
Other - Prefix:DR
Other - First Name:PILAR
Other - Middle Name:ANTONIA
Other - Last Name:GONZALEZ-GREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4102
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95617-4102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:207 E ST STE B
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4523
Practice Address - Country:US
Practice Address - Phone:530-206-9996
Practice Address - Fax:530-206-9996
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29780103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY29780OtherBOARD OF PSYCHOLOGY