Provider Demographics
NPI:1992591457
Name:GONZALEZ, SARA MARIE
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:GONZALEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 G ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-1259
Mailing Address - Country:US
Mailing Address - Phone:925-779-7500
Mailing Address - Fax:
Practice Address - Street 1:5150 LIVE OAK AVE
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-4127
Practice Address - Country:US
Practice Address - Phone:925-779-7746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach