Provider Demographics
NPI:1851639827
Name:GONZALES, ANGELICA (BCBA, PSYD)
Entity type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:BCBA, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8041 FLORENCE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3845
Mailing Address - Country:US
Mailing Address - Phone:562-454-7998
Mailing Address - Fax:
Practice Address - Street 1:8041 FLORENCE AVE STE 202
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3845
Practice Address - Country:US
Practice Address - Phone:562-454-7998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
CA33160103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst