Provider Demographics
NPI:1871967612
Name:GONZALEZ, MARIA DEL CARMEN (CPHW/MA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DEL CARMEN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:CPHW/MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 DOVERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-5808
Mailing Address - Country:US
Mailing Address - Phone:626-277-2251
Mailing Address - Fax:
Practice Address - Street 1:552 DOVERDALE AVE
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-5808
Practice Address - Country:US
Practice Address - Phone:626-277-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker