Provider Demographics
NPI:1033410444
Name:GONZALEZ, DOLORES J
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:J
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 1:3747 FOOTHILL BLVD # B517
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1700
Mailing Address - Country:US
Mailing Address - Phone:424-388-1038
Mailing Address - Fax:
Practice Address - Street 1:1191 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1868
Practice Address - Country:US
Practice Address - Phone:424-388-1038
Practice Address - Fax:818-830-0206
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2020-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 225400000X
CAASW606961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner