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NPI Code Detail

MEDICARE: NARDA IRIS GONZALEZ

MEDICARE:   NARDA IRIS GONZALEZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist
2390200000XStudent in an Organized Health Care Education/Training ProgramPSB94023590CA
3103T00000XPsychologistPSB94023590CA

General Provider Information

NPI Number : 1083094668
Entity Type Code : Individual
Provider Name (Legal Business Name) : NARDA IRIS GONZALEZ
Provider Business Mailing Address
First Line : 18646 OXNARD ST
Second Line :
City : TARZANA
State : CA
Zip : 91356-1486
Country : US
Telephone Number : 818-654-3908
Fax Number :
Provider Business Practice Location Address
First Line : 18646 OXNARD ST
Second Line :
City : TARZANA
State : CA
Zip : 91356-1486
Country : US
Telephone Number : 818-654-3908
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2015
Last Update Date : 10/09/2019

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Directions to “ NARDA IRIS GONZALEZ ” Practice Location

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