Active NPI
Breanna Gonzalez
- Occupational Therapist
- Ontario, CA
National Provider Identifier
1023565660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 18791
- Practice address
- 3449 S. Wrangler PL.
Ontario, CA 91761 - Phone
- (909) 919-4901
- NPI assigned
- Sep 1, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Assistant | 2355S0801X | SP 3677 | CA | |
| Occupational Therapist | 225X00000X | 18791 | CA | Primary |
Addresses
Primary practice location
3449 S. Wrangler PL.
Ontario, CA 91761
Mailing address
3449 S. Wrangler PL.
Ontario, CA 91761-9188
Phone (909) 919-4901
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 |
|---|---|---|---|
| SP 3677 | CA | MD | Speech-Language Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528675200000",
"number": "1023565660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3449 S. WRANGLER PL.",
"city": "ONTARIO",
"state": "CA",
"postal_code": "917619188",
"telephone_number": "909-919-4901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3449 S. WRANGLER PL.",
"city": "ONTARIO",
"state": "CA",
"postal_code": "91761",
"telephone_number": "909-919-4901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALEZ",
"first_name": "BREANNA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-09-01",
"last_updated": "2018-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "2355S0801X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Speech-Language Assistant",
"state": "CA",
"license": "SP 3677",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "18791",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ontario, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.