Provider Demographics
NPI:1346639077
Name:GONZALES, STEVEN PAUL
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:PAUL
Last Name:GONZALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4836 N 1ST ST STE 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-0527
Mailing Address - Country:US
Mailing Address - Phone:559-225-2211
Mailing Address - Fax:559-225-2211
Practice Address - Street 1:4836 N 1ST ST STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-0527
Practice Address - Country:US
Practice Address - Phone:559-225-2211
Practice Address - Fax:559-225-2211
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA9094237700000X
CAHA7942237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA7942Medicaid
CAHA9094Medicaid