Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 62475 | CA |
NPI | 1003324872 |
---|---|
Provider Name | Carmen Ann Gonzales I |
First Address | Glendale, CA 91203-1618 |
Second Address | Anaheim, CA 92805-5806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2018 |
Last Update Date | 16/01/2018 |