Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 30339 | CA |
Y | 103TC0700X | Clinical Psychologist | 30339 | CA |
N | 225C00000X | Rehabilitation Counselor | CA |
NPI | 1245631373 |
---|---|
Provider Name | Mr. Stephen Bryan Gonzalez |
First Address | Lakewood, CA 90712-4048 |
Second Address | Lakewood, CA 90712-4048 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2014 |
Last Update Date | 11/05/2020 |