Provider Demographics
NPI:1659928042
Name:GONZALES, TALIA REYLENE
Entity Type:Individual
Prefix:
First Name:TALIA
Middle Name:REYLENE
Last Name:GONZALES
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 1:1441 SCHILLING PL
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4527
Mailing Address - Country:US
Mailing Address - Phone:831-784-2150
Mailing Address - Fax:
Practice Address - Street 1:1441 SCHILLING PL
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4527
Practice Address - Country:US
Practice Address - Phone:831-784-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor