Active NPI
Henry Antonio Gonzalez
- Addiction (Substance Use Disorder) Counselor
- San Rafael, CA
National Provider Identifier
1811278583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 12938
- Practice address
- 603 D St
San Rafael, CA 94901-3719 - Phone
- (415) 454-9444
- NPI assigned
- Sep 7, 2011
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 12938 | IN | Primary |
Addresses
Primary practice location
603 D St
San Rafael, CA 94901-3719
Mailing address
603 D St
San Rafael, CA 94901-3719
Phone (415) 454-9444
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101YA041X | Other | CA | SUBSTANCE ABUSE |
Other names 1
- Mr. Henry Antonio 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 |
|---|---|---|---|
| 12938 | IN | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Center Point | Past | Accepting new patients |
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.
-
- Substance Abuse Rehabilitation Facility
- San Rafael, CA
- NPI 1093178279
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315353600000",
"number": "1811278583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "603 D ST",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949013719",
"telephone_number": "415-454-9444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "603 D ST",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949013719",
"telephone_number": "415-454-9444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALEZ",
"first_name": "HENRY",
"middle_name": "ANTONIO",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-07",
"last_updated": "2011-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "IN",
"license": "12938",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SUBSTANCE ABUSE",
"identifier": "101YA041X",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "HENRY",
"last_name": "GONZALEZ",
"middle_name": "ANTONIO",
"prefix": "MR.",
"credential": "DRUG COUNSELOR",
"code": "5",
"type": "Other Name"
}
]
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.