Individual provider Active NPI

Tina Matilde Gonzalez

  • Marriage & Family Therapist
  • Upland, CA
National Provider Identifier
1396124020
Registry record updated Aug 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
110005 Issued in CA
Practice address
876 N Mountain Ave Ste 200E
Upland, CA 91786-4166
Phone
(909) 766-0096
NPI assigned
May 27, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X IMF 95694 CA
Student in an Organized Health Care Education/Training Program 390200000X
Marriage & Family Therapist 106H00000X 110005 CA Primary

Addresses

Primary practice location

876 N Mountain Ave Ste 200E
Upland, CA 91786-4166

Mailing address

PO Box 1815
Claremont, CA 91711-8815
Phone (909) 766-0096

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Feb 20, 2024 through Feb 20, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
110005CAMDMarriage & Family Therapist
IMF 95694CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Flor Y Siendo Individual and Family Therapy, Professional Corporation Marriage & Family Therapist CurrentSince Apr 1, 2021 Accepting new patients

Locations

12598 Central Ave
Ste 122
Chino, CA 91710
Phone (909) 766-0096

220 S Indian Hill Blvd
Ste D
Claremont, CA 91711
Phone (626) 214-5362

5050 Palo Verde St
Ste 107
Montclair, CA 91763

876 N Mountain Ave
Ste 200E
Upland, CA 91786
Phone (909) 766-0096

Organizations & group practices 1

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": "1432684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756166400000",
    "number": "1396124020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1815",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "917118815",
            "telephone_number": "909-766-0096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "876 N MOUNTAIN AVE STE 200E",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864166",
            "telephone_number": "909-766-0096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "TINA",
        "middle_name": "MATILDE",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-27",
        "last_updated": "2025-08-26",
        "certification_date": "2025-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "IMF 95694",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "110005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

Verify at the official NPI Registry.