Gabrielle Rose Gonzalez, MASTERS

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

LMFT122832 Issued in CA

Practice address

7252 Archibald Ave # 1005
Rancho Cucamonga, CA 91701-5017

Phone

(909) 255-3861

NPI assigned

Sep 11, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Mindful Revamp Inc. Professional name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Mindful Revamp, Inc.

  • Marriage & Family Therapist
  • Rancho Cucamonga, CA
  • NPI 1407748866
  NPD Authorized official

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

{
    "created_epoch": "1505088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1316466428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7252 ARCHIBALD AVE # 1005",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917015017",
            "telephone_number": "909-255-3861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7252 ARCHIBALD AVE # 1005",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917015017",
            "telephone_number": "909-255-3861"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12301 Wilshire Blvd Ste 512",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900251053",
            "country_code": "US",
            "telephone_number": "888-684-2779",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2200 E Route 66 Ste 100",
            "address_purpose": "LOCATION",
            "city": "Glendora",
            "state": "CA",
            "postal_code": "91740",
            "country_code": "US",
            "telephone_number": "626-859-2089",
            "fax_number": "626-859-6537",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "GABRIELLE",
        "middle_name": "ROSE",
        "credential": "MASTERS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-11",
        "last_updated": "2022-07-21",
        "certification_date": "2021-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "AMFT100840",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "122832",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT122832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "mindfulrevampinc.com",
            "affiliation": "N",
            "endpointDescription": "website",
            "address_1": "7252 Archibald Ave # 1005",
            "city": "Rancho Cucamonga",
            "state": "CA",
            "country_code": "US",
            "postal_code": "917015017",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MINDFUL REVAMP",
            "last_name": "INC.",
            "credential": "INCORPORATION",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Dulce Maria Gonzalez
• Edna Violeta Gonzalez
• Elisa Lepe Gonzalez
• Elizabeth Gonzalez
• Emilia Gonzalez
• Jacqueline Gonzalez, AMFT 113958
• Jalisa Annelis Gonzalez
• Jesse Josiah Gonzalez
• Kayley Gonzalez
• Liliana Gonzalez, PT, DPT

• Marriage & Family Therapist in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.