Provider Demographics
NPI:1669264172
Name:GONZALEZ, KIRA (PPS)
Entity type:Individual
Prefix:
First Name:KIRA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-4401
Mailing Address - Country:US
Mailing Address - Phone:805-742-3020
Mailing Address - Fax:
Practice Address - Street 1:515 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-4401
Practice Address - Country:US
Practice Address - Phone:805-742-3020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210114991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health