Provider Demographics
NPI:1982033759
Name:GONZALEZ, DIANA (EDS)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 N BEN MADDOX WAY
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-6623
Mailing Address - Country:US
Mailing Address - Phone:559-625-0331
Mailing Address - Fax:
Practice Address - Street 1:724 N BEN MADDOX WAY
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-6623
Practice Address - Country:US
Practice Address - Phone:559-625-0331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health