Provider Demographics
NPI:1639066715
Name:GONZALES, MELIA (BT)
Entity type:Individual
Prefix:
First Name:MELIA
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 G ST APT 1
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-1665
Mailing Address - Country:US
Mailing Address - Phone:510-677-9788
Mailing Address - Fax:
Practice Address - Street 1:2000 POWELL ST STE 900
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-1888
Practice Address - Country:US
Practice Address - Phone:510-542-5775
Practice Address - Fax:844-691-2086
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician