Provider Demographics
NPI:1326263054
Name:GONZALEZ, SARA
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
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 1:241 E LAKE AVE
Mailing Address - Street 2:A
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-4717
Mailing Address - Country:US
Mailing Address - Phone:831-688-8856
Mailing Address - Fax:
Practice Address - Street 1:241 E LAKE AVE
Practice Address - Street 2:A
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4717
Practice Address - Country:US
Practice Address - Phone:831-688-8856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7820101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ92069ZOtherNON-MEDICARE
CAZZZ92069ZOtherSANTA CRUZ COUNTY MEDICARE GROUP PTAN#
ZZZ91892ZOtherSANTA CRUZ COUNTY MEDICARE GROUP PTAN#