Basic Information
| Provider Information | |||||||||
| NPI: | 1326263054 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 241 E LAKE AVE | ||||||||
| Address2: | A | ||||||||
| City: | WATSONVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950764717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316888856 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 241 E LAKE AVE | ||||||||
| Address2: | A | ||||||||
| City: | WATSONVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950764717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316888856 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2007 | ||||||||
| LastUpdateDate: | 08/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 7820 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | ZZZ92069Z | 01 | CA | NON-MEDICARE | OTHER | ZZZ92069Z | 01 | CA | SANTA CRUZ COUNTY MEDICARE GROUP PTAN# | OTHER | ZZZ91892Z | 01 | SANTA CRUZ COUNTY MEDICARE GROUP PTAN# | OTHER |