Provider Demographics
NPI:1427324771
Name:GONZALEZ, VICTORIA T
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:T
Last Name:GONZALEZ
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 1:339 PAJARO ST STE D
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3400
Mailing Address - Country:US
Mailing Address - Phone:831-800-7530
Mailing Address - Fax:831-975-5862
Practice Address - Street 1:41 E SAN LUIS ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3437
Practice Address - Country:US
Practice Address - Phone:831-676-3715
Practice Address - Fax:831-975-5862
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA97976106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA51-0159122Medicaid