Provider Demographics
NPI:1053196063
Name:GONZALEZ, TERESA A
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6730 4TH AVE APT 1513
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2672
Mailing Address - Country:US
Mailing Address - Phone:209-312-8257
Mailing Address - Fax:
Practice Address - Street 1:5735 47TH AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95824-4528
Practice Address - Country:US
Practice Address - Phone:916-422-0571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician