Provider Demographics
NPI:1457888570
Name:GONZALES, XOCHILT REBECCA (CADAC II)
Entity Type:Individual
Prefix:
First Name:XOCHILT
Middle Name:REBECCA
Last Name:GONZALES
Suffix:
Gender:F
Credentials:CADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3430
Mailing Address - Country:US
Mailing Address - Phone:916-796-0020
Mailing Address - Fax:916-796-0045
Practice Address - Street 1:3990 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3430
Practice Address - Country:US
Practice Address - Phone:916-796-0020
Practice Address - Fax:916-796-0045
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA06610315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)