Provider Demographics
NPI:1235973587
Name:GONZALEZ, KEVIN ALEXIS
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:ALEXIS
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 ALDER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-0106
Mailing Address - Country:US
Mailing Address - Phone:626-825-0148
Mailing Address - Fax:
Practice Address - Street 1:2619 ALDER CREEK DR
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-0106
Practice Address - Country:US
Practice Address - Phone:626-825-0148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician