Provider Demographics
NPI:1235786120
Name:GONZALEZ, BRIANA KORINNA
Entity type:Individual
Prefix:MRS
First Name:BRIANA
Middle Name:KORINNA
Last Name:GONZALEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17647 MCWETHY DR APT 3
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-2781
Mailing Address - Country:US
Mailing Address - Phone:626-438-5855
Mailing Address - Fax:
Practice Address - Street 1:17647 MCWETHY DR APT 3
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-2781
Practice Address - Country:US
Practice Address - Phone:626-438-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-24
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA41436167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty