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General NPI Number Information
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NPI Number | 1548139900
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Entity Type | Individual
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Provider Name | MIRIAM GONZALEZ RN
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Gender | Female
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 510 S VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90020-1912
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Country | US
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Telephone | 562-403-0101
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3771
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City | SAN DIMAS
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State | CA
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Zip | 91773-7771
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Country | US
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Telephone | 626-590-9367
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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 | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | 95144011
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License Number State | CA
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