Healthcare Provider Details

I. General information

NPI: 1093699118
Provider Name (Legal Business Name): CHRISTINA GONZALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3881 S WESTERN AVE
LOS ANGELES CA
90062-1105
US

IV. Provider business mailing address

11008 ZEUS AVE
NORWALK CA
90650-1870
US

V. Phone/Fax

Practice location:
  • Phone: 323-290-4340
  • Fax:
Mailing address:
  • Phone: 562-805-0581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW140876
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: