Healthcare Provider Details

I. General information

NPI: 1629932447
Provider Name (Legal Business Name): ANDREA VALTIERRA-GONGORA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 13TH ST
MERCED CA
95341-6211
US

IV. Provider business mailing address

301 E 13TH ST
MERCED CA
95341-6211
US

V. Phone/Fax

Practice location:
  • Phone: 209-381-3800
  • Fax:
Mailing address:
  • Phone: 209-381-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW137802
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number042A70EEE4
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: