Individual provider Active NPI

Martha Gonzalez, PSYCHIATRIC TECH

  • Licensed Psychiatric Technician
  • Pomona, CA
National Provider Identifier
1215472105
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Psychiatric TechnicianTaxonomy code 167G00000X
License
PT34747 Issued in CA
Practice address
2008 N Garey Ave
Pomona, CA 91767-2722
Phone
(909) 623-6131
Fax
(909) 865-9281
NPI assigned
Dec 30, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Psychiatric Technician 167G00000X PT34747 CA Primary
Licensed Psychiatric Technician 167G00000X

Addresses

Primary practice location

2008 N Garey Ave
Pomona, CA 91767-2722

Mailing address

850 E Foothill Blvd
Rialto, CA 92376-5230
Phone (909) 421-9309

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

LicenseStateTypeSpecialty
PT34747CAMDLicensed Psychiatric Technician

Practice roles

OrganizationSpecialtyStatusNew patients
Tri-City Mental Health Authority CurrentSince Nov 17, 2024 Accepting new patients
Tri-City Mental Health Center PastSince Nov 17, 2024 Accepting new patients

Locations

2008 N Garey Ave
Pomona, CA 91767
Phone (909) 242-7640

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1483056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1215472105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 E FOOTHILL BLVD",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923765230",
            "telephone_number": "909-421-9309",
            "fax_number": "909-421-9219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2008 N GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917672722",
            "telephone_number": "909-623-6131",
            "fax_number": "909-865-9281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "MARTHA",
        "credential": "PSYCHIATRIC TECH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-12-30",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "167G00000X",
            "taxonomy_group": "",
            "desc": "Licensed Psychiatric Technician",
            "state": "CA",
            "license": "PT34747",
            "primary": true
        },
        {
            "code": "167G00000X",
            "taxonomy_group": "",
            "desc": "Licensed Psychiatric Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.