Provider Demographics
NPI:1578166526
Name:GONZALEZ, RAUL A
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:A
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:PROF
Other - First Name:RAUL
Other - Middle Name:A
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1486 JUDSON WAY
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-5251
Mailing Address - Country:US
Mailing Address - Phone:619-341-3120
Mailing Address - Fax:800-350-1432
Practice Address - Street 1:1486 JUDSON WAY
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-5251
Practice Address - Country:US
Practice Address - Phone:619-341-3120
Practice Address - Fax:800-350-1432
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician