Provider Demographics
NPI:1134953466
Name:GONZALEZ, BROOKE ANGEL I
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANGEL
Last Name:GONZALEZ
Suffix:I
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 1:10019 PICO VISTA RD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3539
Mailing Address - Country:US
Mailing Address - Phone:714-603-1850
Mailing Address - Fax:
Practice Address - Street 1:10019 PICO VISTA RD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3539
Practice Address - Country:US
Practice Address - Phone:562-393-2586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst