Provider Demographics
NPI:1437807674
Name:GONZALEZ, CRISTA (LEP)
Entity type:Individual
Prefix:
First Name:CRISTA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1931
Mailing Address - Country:US
Mailing Address - Phone:310-367-2368
Mailing Address - Fax:
Practice Address - Street 1:116 S CATALINA AVE STE 118
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3388
Practice Address - Country:US
Practice Address - Phone:310-367-2368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP3469103TC1900X, 103T00000X
103T00000X
CA3469103TC1900X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool