Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003206293 |
---|---|
Provider Name | Paul Cesar Gonzalez Hernandez |
First Address | Santa Rosa, CA 95405 |
Second Address | Santa Rosa, CA 95401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2015 |
Last Update Date | 24/02/2015 |