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NPI Code Detail

MEDICARE: MR. JOSE ANGEL GONZALEZ MSW INTERN

MEDICARE: MR. JOSE ANGEL GONZALEZ MSW INTERN
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
1101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1101YM0800XOTHERCA101YM0800X

General Provider Information

NPI Number : 1649613654
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSE ANGEL GONZALEZ MSW INTERN
Provider Business Mailing Address
First Line : 44-199 MONROE ST
Second Line : SUITE C
City : INDIO
State : CA
Zip : 92201-3094
Country : US
Telephone Number : 760-863-2907
Fax Number : 760-863-2569
Provider Business Practice Location Address
First Line : 44199 MONROE ST STE C
Second Line :
City : INDIO
State : CA
Zip : 92201-3094
Country : US
Telephone Number : 760-863-2907
Fax Number : 760-863-2569
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2013
Last Update Date : 09/02/2016

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