Provider Demographics
NPI:1164864294
Name:GONZALEZ, VIVED (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VIVED
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31473 RANCHO VIEJO RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1862
Mailing Address - Country:US
Mailing Address - Phone:949-200-7723
Mailing Address - Fax:949-281-5243
Practice Address - Street 1:31473 RANCHO VIEJO RD STE 102
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1862
Practice Address - Country:US
Practice Address - Phone:949-200-7723
Practice Address - Fax:949-281-5243
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CALMFT89060103TC1900X
CA106H00000X
AZLMFT15560106H00000X
CAMFT89060106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling