MEDICARE: ELVIRA 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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor		CA
2	171M00000X	Case Manager/Care Coordinator		CA

General Provider Information

NPI Number	:	1427541580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELVIRA GONZALEZ

Provider Business Mailing Address
First Line	:	351 E 6TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-1402
Country	:	US
Telephone Number	:	562-435-7350
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 ELM AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-1406
Country	:	US
Telephone Number	:	562-435-7350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2018
Last Update Date	:	01/17/2023

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Directions to “ ELVIRA GONZALEZ ” Practice Location

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