Provider Demographics
NPI:1942437645
Name:GONZALEZ, DESIREE ROSE
Entity Type:Individual
Prefix:MS
First Name:DESIREE
Middle Name:ROSE
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 1:13104 PHILADELPHIA ST STE 217
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-6312
Mailing Address - Country:US
Mailing Address - Phone:562-277-1059
Mailing Address - Fax:
Practice Address - Street 1:13104 PHILADELPHIA ST STE 217
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-6312
Practice Address - Country:US
Practice Address - Phone:562-277-1059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51711106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist