Provider Demographics
NPI:1992676704
Name:GONZALEZ, DIANA O (MED, PPSC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:O
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MED, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 STANISLAUS ST
Mailing Address - Street 2:
Mailing Address - City:FIREBAUGH
Mailing Address - State:CA
Mailing Address - Zip Code:93622-2257
Mailing Address - Country:US
Mailing Address - Phone:559-269-5651
Mailing Address - Fax:
Practice Address - Street 1:1880 HANLON WAY
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-3579
Practice Address - Country:US
Practice Address - Phone:925-473-2470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool