Healthcare Provider Details

I. General information

NPI: 1619060340
Provider Name (Legal Business Name): RAUL MUNGIA GONZALES MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 11/23/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4970 NORTHWIND STE220
EAST LANSING MI
48823-5032
US

IV. Provider business mailing address

3620 ARAGON
LANSING MI
48906
US

V. Phone/Fax

Practice location:
  • Phone: 989-345-1000
  • Fax: 989-345-5803
Mailing address:
  • Phone: 517-321-8356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801012156
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: