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1145 E Clark Ave Ste K Santa Maria CA 93455-5173 | |
| (805) 203-6202 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 1145 E Clark Ave Ste K, Santa Maria, California |
| Authorized Official Name and Position | Ada Gonzales (PRESIDENT) |
| Authorized Official Contact | 8052036202 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
843 Mccloud St Santa Maria CA 93455-7108 Ph: (805) 203-6202 | 1145 E Clark Ave Ste K Santa Maria CA 93455-5173 Ph: (805) 203-6202 |
| NPI Number | 1447804133 |
|---|---|
| Provider Enumeration Date | 07/31/2019 |
| Last Update Date | 12/06/2019 |
| Medicare PECOS PAC ID | 5092149492 |
|---|---|
| Medicare Enrollment ID | O20191217002929 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447804133 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Ada Eunice Gonzales |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851867550 PECOS PAC ID: 4082958020 Enrollment ID: I20181203002347 |
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