Healthcare Provider Details

I. General information

NPI: 1396948345
Provider Name (Legal Business Name): GRACIELA GONZALEZ ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 GUADALUPE PKWY
SAN JOSE CA
95110-1714
US

IV. Provider business mailing address

840 GUADALUPE PKWY
SAN JOSE CA
95110-1714
US

V. Phone/Fax

Practice location:
  • Phone: 408-299-3166
  • Fax: 408-971-2651
Mailing address:
  • Phone: 408-299-3166
  • Fax: 408-971-2651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: