Provider Demographics
NPI:1629773726
Name:GONZALES, STEPHEN J
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:GONZALES
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 1:505 N TUSTIN AVE STE 228
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3735
Mailing Address - Country:US
Mailing Address - Phone:949-446-9938
Mailing Address - Fax:
Practice Address - Street 1:505 N TUSTIN AVE STE 228
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3735
Practice Address - Country:US
Practice Address - Phone:949-446-9938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician