Provider Demographics
NPI:1134367881
Name:GONZALEZ, SANDRA PATRICIA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:PATRICIA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4928 E CLINTON WAY
Mailing Address - Street 2:STE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1526
Mailing Address - Country:US
Mailing Address - Phone:559-452-8106
Mailing Address - Fax:
Practice Address - Street 1:4928 E CLINTON WAY
Practice Address - Street 2:STE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1526
Practice Address - Country:US
Practice Address - Phone:559-452-8106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)