Provider Demographics
NPI:1518781939
Name:GONZALEZ, VICTORIA SCHIZANDRA
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:SCHIZANDRA
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 1:168 STONEGATE RD APT 301
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-7595
Mailing Address - Country:US
Mailing Address - Phone:820-222-6393
Mailing Address - Fax:
Practice Address - Street 1:168 STONEGATE RD APT 301
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-7595
Practice Address - Country:US
Practice Address - Phone:820-222-6393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY5688432106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician