Provider Demographics
NPI:1184801953
Name:GONZALEZ, RICARDO
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8443 CRENSHAW BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-1900
Mailing Address - Country:US
Mailing Address - Phone:323-750-2850
Mailing Address - Fax:323-750-0851
Practice Address - Street 1:8443 CRENSHAW BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-1900
Practice Address - Country:US
Practice Address - Phone:323-750-2850
Practice Address - Fax:323-750-0851
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor