Healthcare Provider Details

I. General information

NPI: 1366121931
Provider Name (Legal Business Name): GUADALUPE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18623 EAST GALE AVENUE
CITY OF INDUSTRY CA
91748
US

IV. Provider business mailing address

18623 EAST GALE AVENUE
CITY OF INDUSTRY CA
91748
US

V. Phone/Fax

Practice location:
  • Phone: 626-839-0300
  • Fax:
Mailing address:
  • Phone: 626-839-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW140997
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: