Provider Demographics
NPI:1932767373
Name:GONZALEZ, PAUL ANTHONY (CADCII ICADC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ANTHONY
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:CADCII ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:WARNER SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92086-0083
Mailing Address - Country:US
Mailing Address - Phone:760-749-1410
Mailing Address - Fax:760-749-3347
Practice Address - Street 1:50100 GOLSH RD
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:CA
Practice Address - Zip Code:92082-5338
Practice Address - Country:US
Practice Address - Phone:760-749-1410
Practice Address - Fax:760-749-3347
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARA0663015101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARA0663015OtherCCAPP