Provider Demographics
NPI:1326295437
Name:ALONZO, GLORIA GAETA (MA, MFT)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:GAETA
Last Name:ALONZO
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:GAETA
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2852
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255
Mailing Address - Country:US
Mailing Address - Phone:562-422-8472
Mailing Address - Fax:
Practice Address - Street 1:4565 CALIFORNIA AVE.
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807
Practice Address - Country:US
Practice Address - Phone:562-422-8472
Practice Address - Fax:562-422-1102
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF56356106H00000X
CAIMF 79030101YM0800X, 106H00000X
CALMFT 95093106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist