Provider Demographics
NPI:1932851078
Name:GONZALEZ DIAZ, ALEJANDRO SANDOVAL (QMHA, CADA)
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:SANDOVAL
Last Name:GONZALEZ DIAZ
Suffix:
Gender:M
Credentials:QMHA, CADA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 NW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-6600
Mailing Address - Country:US
Mailing Address - Phone:909-492-1392
Mailing Address - Fax:
Practice Address - Street 1:595 NW 11TH ST
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-6600
Practice Address - Country:US
Practice Address - Phone:541-567-2536
Practice Address - Fax:541-567-2632
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health