Provider Demographics
NPI:1588214704
Name:GONZALEZ, ESTEFANA LUNA
Entity Type:Individual
Prefix:
First Name:ESTEFANA
Middle Name:LUNA
Last Name:GONZALEZ
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 1:2201 W BROADWAY APT B319
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-1305
Mailing Address - Country:US
Mailing Address - Phone:714-606-6549
Mailing Address - Fax:
Practice Address - Street 1:12062 VALLEY VIEW ST STE 103
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-1738
Practice Address - Country:US
Practice Address - Phone:657-444-6002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician