Provider Demographics
NPI:1063928380
Name:GONZALEZ, SHELBY JAMILLE
Entity type:Individual
Prefix:MS
First Name:SHELBY
Middle Name:JAMILLE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23259 JOAQUIN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-3208
Mailing Address - Country:US
Mailing Address - Phone:951-290-1175
Mailing Address - Fax:
Practice Address - Street 1:23259 JOAQUIN RIDGE DR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-3208
Practice Address - Country:US
Practice Address - Phone:951-290-1175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA341173106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician