Individual
LLANEICI GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCMA
Contact information
Practice address
44359 PALM ST, INDIO, CA 92201-3116
(760) 342-6616
Mailing address
46350 TOWNE ST SPC 57, INDIO, CA 92201-5925
(760) 342-6616
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
M3C6M8N4
CA
Other
Enumeration date
10/04/2025
Last updated
10/04/2025
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