Healthcare Provider Details

I. General information

NPI: 1578273645
Provider Name (Legal Business Name): MARGARITA ROSA TORO GONZALEZ CG61349567
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14090 FRYELANDS BLVD SE STE 347
MONROE WA
98272-2760
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 360-805-3122
  • Fax: 360-805-9180
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG61349567
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: