Provider Demographics
NPI:1518019967
Name:GONZALES, MARIA J
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:J
Last Name:GONZALES
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 1:1129 DILLON DR
Mailing Address - Street 2:P.O. BOX 2322
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2305
Mailing Address - Country:US
Mailing Address - Phone:707-257-4593
Mailing Address - Fax:707-257-4593
Practice Address - Street 1:2344 OLD SONOMA RD
Practice Address - Street 2:BLDG-H-137
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-3708
Practice Address - Country:US
Practice Address - Phone:707-259-8676
Practice Address - Fax:707-259-8651
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CAIMF91650106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No174400000XOther Service ProvidersSpecialist