Provider Demographics
NPI:1568219301
Name:GONZALEZ, GRISELDA V
Entity type:Individual
Prefix:
First Name:GRISELDA
Middle Name:V
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6061 CECILIA ST
Mailing Address - Street 2:
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201-6222
Mailing Address - Country:US
Mailing Address - Phone:323-949-9221
Mailing Address - Fax:
Practice Address - Street 1:2115 W CRESCENT AVE STE 244
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-3836
Practice Address - Country:US
Practice Address - Phone:714-829-4138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical