Provider Demographics
NPI:1659841849
Name:GONZALEZ, JUDITH
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
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 1:4455 MURPHY CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4379
Mailing Address - Country:US
Mailing Address - Phone:619-482-7100
Mailing Address - Fax:818-241-6853
Practice Address - Street 1:4455 MURPHY CANYON RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4379
Practice Address - Country:US
Practice Address - Phone:619-482-7100
Practice Address - Fax:818-241-6853
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician