Provider Demographics
NPI:1194311985
Name:GONZALEZ RUIZ, MONSERRAT
Entity type:Individual
Prefix:
First Name:MONSERRAT
Middle Name:
Last Name:GONZALEZ RUIZ
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 1:2300 OAKDALE RD APT 31
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2689
Mailing Address - Country:US
Mailing Address - Phone:559-647-6427
Mailing Address - Fax:
Practice Address - Street 1:2300 OAKDALE RD APT 31
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2689
Practice Address - Country:US
Practice Address - Phone:559-647-6427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral