Provider Demographics
NPI:1598801201
Name:GONZALEZ, CAMILO
Entity Type:Individual
Prefix:MR
First Name:CAMILO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 GRAND AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3641
Mailing Address - Country:US
Mailing Address - Phone:650-244-0305
Mailing Address - Fax:650-244-1447
Practice Address - Street 1:301 GRAND AVE STE 301
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-3641
Practice Address - Country:US
Practice Address - Phone:650-244-0305
Practice Address - Fax:650-244-1447
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA99037OtherOLLIN- PROP. 36
CA38932OtherAVIVA- MOM
CA97037OtherOLLIN
CA38241OtherHORIZONS UNLIMITED
CA41491OtherENTRE FAMILIA - OP
CA38472OtherQUETZAL
CA38935OtherAVIVA- BABIES