Provider Demographics
NPI:1306194196
Name:GONZALES, CHRISTOPHER MEDINA JR (ASW)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MEDINA
Last Name:GONZALES
Suffix:JR
Gender:M
Credentials:ASW
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1340 TULLY RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-3055
Mailing Address - Country:US
Mailing Address - Phone:408-271-3900
Mailing Address - Fax:
Practice Address - Street 1:1340 TULLY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-3055
Practice Address - Country:US
Practice Address - Phone:408-271-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical