Provider Demographics
NPI:1649759135
Name:GONZALEZ, ANDREW DAVID
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:DAVID
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 1:41880 KALMIA ST STE 115
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-8835
Mailing Address - Country:US
Mailing Address - Phone:562-233-2260
Mailing Address - Fax:
Practice Address - Street 1:41880 KALMIA ST STE 115
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8835
Practice Address - Country:US
Practice Address - Phone:562-233-2260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105238106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist