Provider Demographics
NPI:1316825367
Name:GONZALES, DOLORES BRISENO
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:BRISENO
Last Name:GONZALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DOLORES
Other - Middle Name:
Other - Last Name:BRISENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:597 WOODCREST DR APT 3
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-7004
Mailing Address - Country:US
Mailing Address - Phone:951-358-9200
Mailing Address - Fax:
Practice Address - Street 1:24910 LAS BRISAS RD STE 117
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4035
Practice Address - Country:US
Practice Address - Phone:951-465-3664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1201591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical