Provider Demographics
NPI:1013970995
Name:GONZALEZ, DAIANA A
Entity Type:Individual
Prefix:MS
First Name:DAIANA
Middle Name:A
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 1:330 E 700 S
Mailing Address - Street 2:#306
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-4062
Mailing Address - Country:US
Mailing Address - Phone:801-787-7979
Mailing Address - Fax:
Practice Address - Street 1:3600 MARKET ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84119-3783
Practice Address - Country:US
Practice Address - Phone:801-787-7979
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist