Provider Demographics
NPI:1750747473
Name:GONZALES, DANIEL II
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GONZALES
Suffix:II
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 1:8898 CLAIREMONT MESA BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1127
Mailing Address - Country:US
Mailing Address - Phone:858-715-1211
Mailing Address - Fax:
Practice Address - Street 1:8898 CLAIREMONT MESA BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1127
Practice Address - Country:US
Practice Address - Phone:858-715-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)