Provider Demographics
NPI:1639500390
Name:GONZALEZ, MARIA RENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:RENE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1702 STANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-3063
Mailing Address - Country:US
Mailing Address - Phone:661-721-2345
Mailing Address - Fax:661-721-6262
Practice Address - Street 1:2737 WEST CECIL AVE
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93216-9120
Practice Address - Country:US
Practice Address - Phone:661-721-2345
Practice Address - Fax:661-721-6262
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17039103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical