Provider Demographics
NPI:1689958191
Name:GONZALEZ, MARIO HARO (BA)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:HARO
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-1269
Mailing Address - Country:US
Mailing Address - Phone:661-322-3276
Mailing Address - Fax:661-323-6259
Practice Address - Street 1:1509 E 11TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-1269
Practice Address - Country:US
Practice Address - Phone:661-322-3276
Practice Address - Fax:661-323-6259
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker