Healthcare Provider Details

I. General information

NPI: 1134096480
Provider Name (Legal Business Name): BRANAE K GONSALVES ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 E LOS ANGELES AVE
SIMI VALLEY CA
93065-2871
US

IV. Provider business mailing address

10346 WHITAKER AVE
GRANADA HILLS CA
91344-7315
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-6830
  • Fax:
Mailing address:
  • Phone: 808-763-8082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number134270
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: