Provider Demographics
NPI:1245631373
Name:GONZALEZ, STEPHEN BRYAN (PHD)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:BRYAN
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:3835 N FREEWAY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1954
Mailing Address - Country:US
Mailing Address - Phone:916-576-7900
Mailing Address - Fax:916-277-9380
Practice Address - Street 1:3333 SKYPARK DR STE 220
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5035
Practice Address - Country:US
Practice Address - Phone:310-257-5750
Practice Address - Fax:310-257-5753
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA171M00000X, 225C00000X
390200000X
CA30339103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program