Provider Demographics
NPI:1447084041
Name:AMBRIZ GONZALEZ, GISELL
Entity type:Individual
Prefix:
First Name:GISELL
Middle Name:
Last Name:AMBRIZ 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 1:670 7TH ST APT 501
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4285
Mailing Address - Country:US
Mailing Address - Phone:707-774-3146
Mailing Address - Fax:
Practice Address - Street 1:110 ELLIS ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3305
Practice Address - Country:US
Practice Address - Phone:707-774-3146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool