Provider Demographics
NPI:1497223986
Name:LEON-GONZALEZ, IRAIS
Entity Type:Individual
Prefix:
First Name:IRAIS
Middle Name:
Last Name:LEON-GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IRAIS
Other - Middle Name:
Other - Last Name:LEON DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-4319
Mailing Address - Country:US
Mailing Address - Phone:805-598-6107
Mailing Address - Fax:
Practice Address - Street 1:105 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-4319
Practice Address - Country:US
Practice Address - Phone:805-928-1707
Practice Address - Fax:805-922-4797
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW86521101YM0800X
CALCSW1109251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health