Basic Information
| Provider Information | |||||||||
| NPI: | 1225663990 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEDINA GONZALEZ | ||||||||
| FirstName: | MARICELA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 EXECUTIVE PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941343394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156560116 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | ALTERNATIVE FAMILY SERVICES | ||||||||
| Address2: | 250 EXECUTIVE PARK BLVD | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156560116 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2020 | ||||||||
| LastUpdateDate: | 10/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | APCC8435 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.