MEDICARE: PAOLO ROMANO SALONGA GARGANTIEL

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	LCS 23509	CA
2	1041C0700X	Clinical Social Worker	23509	CA

General Provider Information

NPI Number	:	1174650089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAOLO ROMANO SALONGA GARGANTIEL

Provider Business Mailing Address
First Line	:	1340 ARNOLD DR STE 200
Second Line	:
City	:	MARTINEZ
State	:	CA
Zip	:	94553-4189
Country	:	US
Telephone Number	:	925-655-2404
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 ARNOLD DR STE 200
Second Line	:
City	:	MARTINEZ
State	:	CA
Zip	:	94553-4189
Country	:	US
Telephone Number	:	925-655-2404
Fax Number	:

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	12/22/2022

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