Healthcare Provider Details

I. General information

NPI: 1881970952
Provider Name (Legal Business Name): JOE GANGL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 N COTTONWOOD ST
WOODLAND CA
95695-6646
US

IV. Provider business mailing address

730 MEDICAL CENTER CT
CHULA VISTA CA
91911-6618
US

V. Phone/Fax

Practice location:
  • Phone: 530-312-4560
  • Fax:
Mailing address:
  • Phone: 619-397-6978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW125006
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: