Provider Demographics
NPI:1629787577
Name:GONZALEZ, LAURA DEBORAH
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:DEBORAH
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 1:210 N BEECHWOOD AVE APT 348
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-7942
Mailing Address - Country:US
Mailing Address - Phone:323-637-2567
Mailing Address - Fax:
Practice Address - Street 1:210 N BEECHWOOD AVE APT 348
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-7942
Practice Address - Country:US
Practice Address - Phone:323-637-2567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty