MEDICARE: MRS. KARLA GABRIELA ANTE-GONZALEZ

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
1	101YM0800X	Mental Health Counselor	100677	CA
2	101YM0800X	Mental Health Counselor	147707	CA
3	225400000X	Rehabilitation Practitioner
4	390200000X	Student in an Organized Health Care Education/Training Program
5	106H00000X	Marriage & Family Therapist	147707	CA

General Provider Information

NPI Number	:	1104221712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KARLA GABRIELA ANTE-GONZALEZ

Provider Business Mailing Address
First Line	:	12281 NELSON ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92840-3205
Country	:	US
Telephone Number	:	714-663-6558
Fax Number	:

Provider Business Practice Location Address
First Line	:	12281 NELSON ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92840-3205
Country	:	US
Telephone Number	:	714-663-6558
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2014
Last Update Date	:	05/15/2025

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