MEDICARE: SANDRA 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	1041C0700X	Clinical Social Worker	80134	CA

General Provider Information

NPI Number	:	1669794822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA GONZALEZ

Provider Business Mailing Address
First Line	:	11835 CARMEL MOUNTAIN RD # 1304342
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-4609
Country	:	US
Telephone Number	:	760-334-9881
Fax Number	:

Provider Business Practice Location Address
First Line	:	11835 CARMEL MOUNTAIN RD # 1304342
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-4609
Country	:	US
Telephone Number	:	760-334-9881
Fax Number	:

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

Provider Enumeration Date	:	02/15/2010
Last Update Date	:	04/10/2024

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