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NPI Code Detail

MEDICARE: MS. ADRIANA G GONZALEZ LCSW

MEDICARE: MS. ADRIANA G GONZALEZ LCSW
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
1104100000XSocial Worker83583CA
21041C0700XClinical Social Worker110127CA

General Provider Information

NPI Number : 1104081215
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ADRIANA G GONZALEZ LCSW
Provider Business Mailing Address
First Line : 940 AVENUE 64
Second Line :
City : PASADENA
State : CA
Zip : 91105-2711
Country : US
Telephone Number : 323-543-2800
Fax Number : 323-978-1263
Provider Business Practice Location Address
First Line : 149 PASADENA AVE STE A
Second Line :
City : SOUTH PASADENA
State : CA
Zip : 91030-3351
Country : US
Telephone Number : 323-274-3065
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2008
Last Update Date : 12/22/2023

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