Provider Demographics
NPI:1841542677
Name:GONZALEZ, VERONICA (MS)
Entity type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 E THELBORN ST
Mailing Address - Street 2:47
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1451
Mailing Address - Country:US
Mailing Address - Phone:951-640-8101
Mailing Address - Fax:
Practice Address - Street 1:1840 E THELBORN ST
Practice Address - Street 2:47
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1451
Practice Address - Country:US
Practice Address - Phone:951-640-8101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF63889106H00000X
CA53162106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist