Individual
JENIFER GONZALEZ BANUELOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3075 MYERS ST, RIVERSIDE, CA 92503-5525
(951) 358-4625
Mailing address
PO BOX 1221, RIALTO, CA 92377-1221
(909) 676-4117
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
122392
CA
1041C0700X
Clinical Social Worker
122392
CA
Other
Enumeration date
04/16/2024
Last updated
09/12/2024
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