Provider Demographics
NPI:1366087397
Name:GONZALEZ, CYNTHIA EVELYN
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:EVELYN
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 1:2656 BARNACLE CV
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-1521
Mailing Address - Country:US
Mailing Address - Phone:909-224-4007
Mailing Address - Fax:
Practice Address - Street 1:2200 OUTLET CENTER DR STE 430
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0611
Practice Address - Country:US
Practice Address - Phone:805-278-0799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114088106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist