Healthcare Provider Details

I. General information

NPI: 1508077454
Provider Name (Legal Business Name): MONICA GORRINDO WALTERS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONICA LEA GORRINDO MSW

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250.W CITRUS GROVE AVE STE 150
OXNARD CA
93030
US

IV. Provider business mailing address

3010 LEEWARD WAY
OXNARD CA
93035-2415
US

V. Phone/Fax

Practice location:
  • Phone: 805-983-6384
  • Fax:
Mailing address:
  • Phone: 805-985-6962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS8274
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: