Provider Demographics
NPI:1336337294
Name:GONZALEZ, BALTIMORE JOSHUA IV
Entity Type:Individual
Prefix:
First Name:BALTIMORE
Middle Name:JOSHUA
Last Name:GONZALEZ
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N BLACKSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-1914
Mailing Address - Country:US
Mailing Address - Phone:559-498-0241
Mailing Address - Fax:559-498-6220
Practice Address - Street 1:515 S CEDAR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702-2908
Practice Address - Country:US
Practice Address - Phone:559-600-6084
Practice Address - Fax:559-600-6084
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor