Gonzales, Mitzi Michelle

Gonzales, Mitzi Michelle is an individual health care provider with primary practice located at 444 S San Vicente Blvd Ste 103 , Los Angeles CA 90048-4169. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical Neuropsychologist, which is considered as her primary health care specialty. Gonzales, Mitzi Michelle can be contacted via phone (310) 423-9722.

Contact Information

Primary practice address
444 S San Vicente Blvd Ste 103 Los Angeles CA 90048-4169
Phone: (310) 423-9722
Fax: (310) 248-8710
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Neuropsychologist 103G00000X 36697 Texas
Behavioral Health & Social Service Providers / Clinical Neuropsychologist 103G00000X PSY28558 California

Profile Details

NPI number 1659806123
LBN Legal business name Gonzales, Mitzi Michelle
Credentials PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 21st, 2017
Last updated Dec 7th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659806123 NPPES
Texas MEDICAID 382200901
Texas Other 382200902

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