Provider Demographics
NPI:1881117547
Name:GONZALEZ, SAIRA (CADC-III)
Entity type:Individual
Prefix:MRS
First Name:SAIRA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:CADC-III
Other - Prefix:MS
Other - First Name:SAIRA
Other - Middle Name:
Other - Last Name:UTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC-I
Mailing Address - Street 1:950 N STATE ST STE E
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-1485
Mailing Address - Country:US
Mailing Address - Phone:951-654-2026
Mailing Address - Fax:
Practice Address - Street 1:950 N STATE ST STE E
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-1485
Practice Address - Country:US
Practice Address - Phone:951-654-2026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA136520106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)