Provider Demographics
NPI:1093539868
Name:GONZALEZ GARCIA, RUBICELLI
Entity type:Individual
Prefix:
First Name:RUBICELLI
Middle Name:
Last Name:GONZALEZ GARCIA
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 1:3801 KERN ROAD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-6340
Mailing Address - Country:US
Mailing Address - Phone:509-574-3200
Mailing Address - Fax:509-574-3210
Practice Address - Street 1:3801 KERN ROAD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-6340
Practice Address - Country:US
Practice Address - Phone:509-574-3200
Practice Address - Fax:509-574-3210
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61630229106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst