Basic Information
| Provider Information | |||||||||
| NPI: | 1629274014 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | KARLA | ||||||||
| MiddleName: | ALEXANDRIA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | B.A CASE MANAGER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6311 BALCOM AVE | ||||||||
| Address2: | |||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913166402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187055815 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6800 OWENSMOUTH AVE STE 310 | ||||||||
| Address2: | |||||||||
| City: | CANOGA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913034245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183478565 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2007 | ||||||||
| 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 | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.