Provider Demographics
NPI:1649613654
Name:GONZALEZ, JOSE ANGEL (MSW INTERN)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ANGEL
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44-199 MONROE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-3094
Mailing Address - Country:US
Mailing Address - Phone:760-863-2907
Mailing Address - Fax:760-863-2569
Practice Address - Street 1:44199 MONROE ST STE C
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-3094
Practice Address - Country:US
Practice Address - Phone:760-863-2907
Practice Address - Fax:760-863-2569
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YM0800XOther101YM0800X