Provider Demographics
NPI:1942177720
Name:GONZALES, JOSEMARI (MHW)
Entity type:Individual
Prefix:
First Name:JOSEMARI
Middle Name:
Last Name:GONZALES
Suffix:
Gender:M
Credentials:MHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3467 EDGEWATER PL
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-8398
Mailing Address - Country:US
Mailing Address - Phone:707-980-1052
Mailing Address - Fax:
Practice Address - Street 1:3467 EDGEWATER PL
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-8398
Practice Address - Country:US
Practice Address - Phone:707-980-1052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-17
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)