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General NPI Number Information
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NPI Number | 1093830614
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Entity Type | Individual
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Provider Name | GINA GONZALEZ MFT
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Gender | Female
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 01/28/2011
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Provider Practice Location Address
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Address Line | 4160 GRAND VIEW BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90066-5214
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Country | US
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Telephone | 310-751-1167
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Fax | 310-397-5827
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Provider Business Mailing Address
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Address Line | 13920 OLD HARBOR LN APT 101
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City | MARINA DEL REY
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State | CA
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Zip | 90292-7323
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Country | US
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Telephone | 310-751-1167
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Fax | 310-397-5827
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT47530
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License Number State | CA
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