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NPI Code Detail

MEDICARE: MS. GINA GONZALEZ MFT

MEDICARE: MS. GINA GONZALEZ MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFT47530CA

General Provider Information

NPI Number : 1093830614
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. GINA GONZALEZ MFT
Provider Business Mailing Address
First Line : 13920 OLD HARBOR LN APT 101
Second Line :
City : MARINA DEL REY
State : CA
Zip : 90292-7323
Country : US
Telephone Number : 310-751-1167
Fax Number : 310-397-5827
Provider Business Practice Location Address
First Line : 4160 GRAND VIEW BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90066-5214
Country : US
Telephone Number : 310-751-1167
Fax Number : 310-397-5827
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2007
Last Update Date : 01/28/2011

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