Provider Demographics
NPI:1386155679
Name:GONZALEZ, ANGELINA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24328 VERMONT AVE STE 318
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-2314
Mailing Address - Country:US
Mailing Address - Phone:424-250-9615
Mailing Address - Fax:
Practice Address - Street 1:24328 VERMONT AVE STE 318
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-2314
Practice Address - Country:US
Practice Address - Phone:424-250-9615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32923235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist