Provider Demographics
NPI:1053604850
Name:GONZALEZ, ERICA (RAS I)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RAS I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7475 N PALM AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-5763
Mailing Address - Country:US
Mailing Address - Phone:559-981-5534
Mailing Address - Fax:559-981-5539
Practice Address - Street 1:741 TULARE ST
Practice Address - Street 2:
Practice Address - City:PARLIER
Practice Address - State:CA
Practice Address - Zip Code:93648-2541
Practice Address - Country:US
Practice Address - Phone:559-646-3837
Practice Address - Fax:559-981-5539
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101044101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1044Medicaid