Healthcare Provider Details

I. General information

NPI: 1366715831
Provider Name (Legal Business Name): ANALIS LOPEZ GONZALES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 MADISON AVE FL 4
NEW YORK NY
10029
US

IV. Provider business mailing address

1751 CLOVERFIELD BLVD
SANTA MONICA CA
90404-4007
US

V. Phone/Fax

Practice location:
  • Phone: 646-899-9648
  • Fax: 212-996-9685
Mailing address:
  • Phone: 310-450-0650
  • Fax: 310-883-1221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
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: