Active NPI
Krystelina Gonzalez
- Marriage & Family Therapist
- Victorville, CA
National Provider Identifier
1003117391
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 107677
- Practice address
- 15480 Ramona Ave
Victorville, CA 92392-2421 - Phone
- (760) 243-8140
- NPI assigned
- Nov 3, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 107677 | CA | Primary |
Addresses
Primary practice location
15480 Ramona Ave
Victorville, CA 92392-2421
Mailing address
15480 Ramona Ave
Victorville, CA 92392-2421
Phone (760) 243-8140
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 390200000X | Other | CA | MFT TRAINEE |
| 106H00000X | Other | CA | MFT INTERN |
Other names 1
- Krystelina Gonzalez
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 107677 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288742400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702425600000",
"number": "1003117391",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15480 RAMONA AVE",
"city": "VICTORVILLE",
"state": "CA",
"postal_code": "923922421",
"telephone_number": "760-243-8140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15480 RAMONA AVE",
"city": "VICTORVILLE",
"state": "CA",
"postal_code": "923922421",
"telephone_number": "760-243-8140"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALEZ",
"first_name": "KRYSTELINA",
"name_prefix": "Miss",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-11-03",
"last_updated": "2023-12-13",
"certification_date": "2023-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "107677",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MFT TRAINEE",
"identifier": "390200000X",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MFT INTERN",
"identifier": "106H00000X",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KRYSTELINA",
"last_name": "GONZALEZ",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Victorville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.