=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952525313
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABIGAIL GONZALEZ, MA, MFT, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 815 THIRD AVE
-----------------------------------------------------
City | CHULA VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91911-1307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-997-0957
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 120987
-----------------------------------------------------
City | CHULA VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-997-0957
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ABIGAIL GONZALEZ
-----------------------------------------------------
Credential | MFT
-----------------------------------------------------
Telephone | 619-997-0957
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC36800
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------