MEDICARE: RUBENIA GONZALEZ B.A.

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	1041C0700X	Clinical Social Worker	81029	CA
2	104100000X	Social Worker	81029	CA

General Provider Information

NPI Number	:	1558492553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBENIA GONZALEZ B.A.

Provider Business Mailing Address
First Line	:	1301 PINE AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3124
Country	:	US
Telephone Number	:	310-669-9510
Fax Number	:	310-669-9501

Provider Business Practice Location Address
First Line	:	901 W VICTORIA ST
Second Line	:	SUITE F & G
City	:	COMPTON
State	:	CA
Zip	:	90220-5807
Country	:	US
Telephone Number	:	310-669-9510
Fax Number	:	310-669-9501

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/03/2023

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