Provider Demographics
NPI:1508355140
Name:GONZALEZ, SOLEDAD (BS)
Entity Type:Individual
Prefix:
First Name:SOLEDAD
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 VILLA LN APT 216
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6457
Mailing Address - Country:US
Mailing Address - Phone:707-567-7138
Mailing Address - Fax:
Practice Address - Street 1:6475 SIERRA LN
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2796
Practice Address - Country:US
Practice Address - Phone:925-462-2281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician