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General NPI Number Information
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NPI Number | 1114622255
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Entity Type | Organization
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Legal Business Name | NINA GONZAGA, LICENSED MARRIAGE AND FAMILY THERAPIST, INC.
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Dates
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Enumeration Date | 03/30/2023
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 11440 W. BERNARDO CT SUITE 300
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City | SAN DIEGO
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State | CA
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Zip | 92127
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Country | US
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Telephone | 951-505-0571
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Fax |
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Provider Business Mailing Address
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Address Line | 1125 E BROADWAY # 836
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City | GLENDALE
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State | CA
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Zip | 91205-1315
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Country | US
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Telephone | 951-505-0571
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NINA GONZAGA
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Credential | LMFT
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Telephone | 951-505-0571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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