Provider Demographics
NPI:1316060734
Name:GONZALES, MICHAEL FRANK (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FRANK
Last Name:GONZALES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 BARRANCA PKWY
Mailing Address - Street 2:SUITE 252
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4711
Mailing Address - Country:US
Mailing Address - Phone:194-973-1440
Mailing Address - Fax:949-733-1438
Practice Address - Street 1:4010 BARRANCA PKWY
Practice Address - Street 2:SUITE 252
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4711
Practice Address - Country:US
Practice Address - Phone:194-973-1440
Practice Address - Fax:949-733-1438
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 7993103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical