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General NPI Number Information
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NPI Number | 1083468979
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Entity Type | Individual
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Provider Name | JENIFER GONZALEZ BANUELOS
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Gender | Female
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Dates
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Enumeration Date | 04/16/2024
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 3075 MYERS ST
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City | RIVERSIDE
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State | CA
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Zip | 92503-5525
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Country | US
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Telephone | 951-358-4625
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1221
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City | RIALTO
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State | CA
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Zip | 92377-1221
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Country | US
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Telephone | 909-676-4117
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 122392
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 122392
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License Number State | CA
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