Gonzales, Mark

Gonzales, Mark is an sole proprietor health care provider with primary practice located at 4023 W Douglas Ave , Visalia CA 93291-4185. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is his primary health care specialty. Gonzales, Mark can be contacted via phone (510) 691-0474.

Contact Information

Primary practice address
4023 W Douglas Ave Visalia CA 93291-4185
Phone: (510) 691-0474
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X 5465630291 California
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X LCI10970318 California

Profile Details

NPI number 1619306289
LBN Legal business name Gonzales, Mark
Credentials LAADC-CA LCI10970318
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 4th, 2013
Last updated Mar 7th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619306289 NPPES
California Other 168767 ADDICTION COUNSELOR CERTIFICATION BOARD OF CALIFORNIA

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