Provider Demographics
NPI:1255503165
Name:GONZALEZ, DIANA JEANETTE
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:JEANETTE
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 1:8101 BAY AVE
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93505-2695
Mailing Address - Country:US
Mailing Address - Phone:760-373-2979
Mailing Address - Fax:
Practice Address - Street 1:8101 BAY AVE
Practice Address - Street 2:
Practice Address - City:CALIFORNIA CITY
Practice Address - State:CA
Practice Address - Zip Code:93505-2695
Practice Address - Country:US
Practice Address - Phone:760-373-2979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor