Provider Demographics
NPI:1134814585
Name:GONZALEZ, CIELO (QMHA, CNA, YSS, PSW)
Entity type:Individual
Prefix:
First Name:CIELO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:QMHA, CNA, YSS, PSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 S G ST
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97630-1817
Mailing Address - Country:US
Mailing Address - Phone:541-947-6021
Mailing Address - Fax:541-219-8114
Practice Address - Street 1:35 S G ST
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:OR
Practice Address - Zip Code:97630-1817
Practice Address - Country:US
Practice Address - Phone:541-947-6021
Practice Address - Fax:541-219-8114
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4D7E1C67-F2E8-4471-8175T00000X
OR23-QMHA-R-3641171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist