Provider Demographics
NPI:1265180657
Name:GONZALEZ, ERIKA ESMERALDA
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:ESMERALDA
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 1:2344 BUTANO DR STE C3
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-0617
Mailing Address - Country:US
Mailing Address - Phone:209-818-4283
Mailing Address - Fax:
Practice Address - Street 1:2344 BUTANO DR STE C3
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-0617
Practice Address - Country:US
Practice Address - Phone:916-239-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA8022237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA90-0884363OtherWSADIOLOGY
CA900884363OtherN/A