Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003190281 |
---|---|
Provider Name | Sandra Gonzales |
First Address | San Jose, CA 95112-5857 |
Second Address | San Jose, CA 95112-5857 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2011 |
Last Update Date | 03/01/2022 |