MEDICARE: JULIE MARY 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1811197213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE MARY GONZALEZ B.A.

Provider Business Mailing Address
First Line	:	18302 IRVINE BLVD
Second Line	:	SUITE 300
City	:	TUSTIN
State	:	CA
Zip	:	92780-3435
Country	:	US
Telephone Number	:	714-881-8600
Fax Number	:

Provider Business Practice Location Address
First Line	:	18302 IRVINE BLVD
Second Line	:	SUITE 300
City	:	TUSTIN
State	:	CA
Zip	:	92780-3435
Country	:	US
Telephone Number	:	714-881-8600
Fax Number	:

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

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	11/21/2011

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