Provider Information for 1093830614
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Ms. GINA GONZALEZ MFT
Other Names:Other Name:Mrs. GINA GONZALEZREYNASex: Female
NPI: 1093830614
Last Updated: 2011-01-28
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1093830614 | ||||||||
| Enumeration Date | 2007-03-20 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 13920 OLD HARBOR LN APT 101 MARINA DEL REY, CA 90292-7323 United States Phone: 310-751-1167 | Fax:310-397-5827 | ||||||||
| Primary Practice Address | 4160 GRAND VIEW BLVD LOS ANGELES, CA 90066-5214 United States Phone: 310-751-1167 | Fax:310-397-5827 | ||||||||
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