Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 9963 | CA |
NPI | 1003421314 |
---|---|
Provider Name | Esperanza Gonzales |
First Address | Lodi, CA 95242-3530 |
Second Address | Lodi, CA 95242-3530 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2020 |
Last Update Date | 14/09/2020 |