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General NPI Number Information
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NPI Number | 1366124687
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Entity Type | Individual
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Provider Name | OMAR GONZALEZ LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/04/2023
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 3131 CAMINO DEL RIO N
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City | SAN DIEGO
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State | CA
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Zip | 92108-5701
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Country | US
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Telephone | 951-837-8810
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3261
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City | PALM SPRINGS
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State | CA
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Zip | 92263-3261
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Country | US
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Telephone |
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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 | 25526
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License Number State | CA
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