Provider Demographics
NPI:1578273645
Name:TORO GONZALEZ, MARGARITA ROSA (CG61349567)
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:ROSA
Last Name:TORO GONZALEZ
Suffix:
Gender:F
Credentials:CG61349567
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14090 FRYELANDS BLVD SE STE 347
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2760
Practice Address - Country:US
Practice Address - Phone:360-805-3122
Practice Address - Fax:360-805-9180
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
WACG61349567101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health