Provider Demographics
NPI:1124766209
Name:GONZALEZ, HECTOR JR (BCABA)
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:
Last Name:GONZALEZ
Suffix:JR
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 LANDIS AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2627
Mailing Address - Country:US
Mailing Address - Phone:619-691-1880
Mailing Address - Fax:619-427-7607
Practice Address - Street 1:410 S 4TH ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3009
Practice Address - Country:US
Practice Address - Phone:619-691-1880
Practice Address - Fax:619-427-7607
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-22-13700106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0-22-13700OtherBCABA