Doctor Name: | MR. GARY GONZALES |
NPI Number: | 1235502659 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | R3631214 |
Business Practice Address: | 7885 Annandale Ave Desert Hot Springs, CA - 922401419 |
Business Phone Number: | 7603292924 |
Business Fax Number: | 7602512932 |
Mailing Address: | 7885 Annandale Ave, DESERT HOT SPRINGS |
State: | CA |
Postal Code: | 922401419 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 11/06/2015 |
NPI Last Update Date: | 11/06/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | R3631214 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |