1790828051 NPI number — MS. SANDRA K GONZALES MFC43658

Table of content: MS. SANDRA K GONZALES MFC43658 (NPI 1790828051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790828051 NPI number — MS. SANDRA K GONZALES MFC43658

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALES
Provider First Name:
SANDRA
Provider Middle Name:
K
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MFC43658
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790828051
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 W VISTA WAY
Provider Second Line Business Mailing Address:
STE. # 407
Provider Business Mailing Address City Name:
VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92083-5732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-758-1092
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5380 REPECHO DR
Provider Second Line Business Practice Location Address:
P208
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92124-1713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-427-7613
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2007

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: 106H00000X , with the licence number:  MFC43658 , 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)

  • Identifier: MFC43658 . This is a "MARRIAGE FAMILY THERAPIST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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