Provider Demographics
NPI:1649689993
Name:GONZALES, DANIEL SR
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GONZALES
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:GONZALES
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:RASI
Mailing Address - Street 1:700 N IRWIN ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3814
Mailing Address - Country:US
Mailing Address - Phone:559-538-9300
Mailing Address - Fax:559-538-9307
Practice Address - Street 1:700 N IRWIN ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3814
Practice Address - Country:US
Practice Address - Phone:559-538-9300
Practice Address - Fax:559-538-9307
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-G1306030378101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARI-G1306030378OtherAOD REGISTRATION NUMBER