1053437244 NPI number — DR. DENISE DYANN GONZALES PSYD.

Table of content: DR. DENISE DYANN GONZALES PSYD. (NPI 1053437244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053437244 NPI number — DR. DENISE DYANN GONZALES PSYD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALES
Provider First Name:
DENISE
Provider Middle Name:
DYANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROUQUETTE
Provider Other First Name:
DENISE
Provider Other Middle Name:
DYANN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSYD.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1053437244
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2095 W VISTA WAY
Provider Second Line Business Mailing Address:
SUITE #216
Provider Business Mailing Address City Name:
VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92083-6027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-659-9042
Provider Business Mailing Address Fax Number:
760-639-0110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2095 W VISTA WAY
Provider Second Line Business Practice Location Address:
SUITE #216
Provider Business Practice Location Address City Name:
VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92083-6027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-659-9042
Provider Business Practice Location Address Fax Number:
760-639-0110
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY19182 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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