Provider Demographics
NPI:1619700044
Name:GONZALEZ-TIENDA, EDWARD ANDREW II
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:ANDREW
Last Name:GONZALEZ-TIENDA
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49869 CALHOUN ST STE D
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-9720
Mailing Address - Country:US
Mailing Address - Phone:760-398-9090
Mailing Address - Fax:760-398-9790
Practice Address - Street 1:49869 CALHOUN ST STE D
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-9720
Practice Address - Country:US
Practice Address - Phone:760-398-9090
Practice Address - Fax:760-398-9790
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist