Provider Demographics
NPI:1356577480
Name:GONZALEZ, GUILLERMINA TERESA
Entity type:Individual
Prefix:
First Name:GUILLERMINA
Middle Name:TERESA
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 1:2680 SATURN AVE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255
Mailing Address - Country:US
Mailing Address - Phone:323-589-5880
Mailing Address - Fax:323-589-5886
Practice Address - Street 1:2680 SATURN AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4377
Practice Address - Country:US
Practice Address - Phone:323-589-5880
Practice Address - Fax:323-589-5886
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)