Healthcare Provider Details

I. General information

NPI: 1033410444
Provider Name (Legal Business Name): DOLORES J GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 05/03/2020
Certification Date: 05/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1191 E WALNUT ST
PASADENA CA
91106-1868
US

IV. Provider business mailing address

3747 FOOTHILL BLVD # B517
GLENDALE CA
91214-1700
US

V. Phone/Fax

Practice location:
  • Phone: 424-388-1038
  • Fax: 818-830-0206
Mailing address:
  • Phone: 424-388-1038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW60696
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: