Healthcare Provider Details

I. General information

NPI: 1629417464
Provider Name (Legal Business Name): MS. VERONICA ANGELINA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS VERONICA ANGELINA MORAN

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 BRIDGEGATE DR
DIAMOND BAR CA
91765-3955
US

IV. Provider business mailing address

850 E WARDLOW RD
LONG BEACH CA
90807-4628
US

V. Phone/Fax

Practice location:
  • Phone: 626-960-4844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW75489
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: