Provider Demographics
NPI:1689233686
Name:GONZALEZ, KRISTINA RENE
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:RENE
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 1:434 7TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1803
Mailing Address - Country:US
Mailing Address - Phone:707-267-0740
Mailing Address - Fax:
Practice Address - Street 1:434 7TH ST STE 210
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1803
Practice Address - Country:US
Practice Address - Phone:707-267-0740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker