Basic Information
| Provider Information | |||||||||
| NPI: | 1376769273 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | AIDA | ||||||||
| MiddleName: | ISABEL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | ASW | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 327 S K ST | ||||||||
| Address2: | |||||||||
| City: | TULARE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932745416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596882043 | ||||||||
| FaxNumber: | 5596881304 | ||||||||
| Practice Location | |||||||||
| Address1: | 327 S K ST | ||||||||
| Address2: | |||||||||
| City: | TULARE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932745416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596882043 | ||||||||
| FaxNumber: | 5596881304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ASW 20164 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | ASW 20164 | 01 | CA | BBS LICENSE # | OTHER |