Provider Demographics
NPI:1265206429
Name:GONZALEZ, FERNANDA
Entity type:Individual
Prefix:
First Name:FERNANDA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 ROYALTY DR STE 180
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3046
Mailing Address - Country:US
Mailing Address - Phone:909-766-7340
Mailing Address - Fax:909-865-0730
Practice Address - Street 1:1900 ROYALTY DR STE 180
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3046
Practice Address - Country:US
Practice Address - Phone:909-766-7340
Practice Address - Fax:909-865-0730
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No172V00000XOther Service ProvidersCommunity Health Worker