Organization
KAISER PERMANENTE
Active
Organization
KAISER PERMANENTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA GEORGINA GONZALEZ-LEON LCSW (LCSW)
(503) 308-0524
Entity
Organization
Contact information
Practice address
3550 N INTERSTATE AVE, PORTLAND, OR 97227-1196
(503) 249-5276
Mailing address
608 SE 112TH AVE, PORTLAND, OR 97216-3414
(503) 308-0524
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
LCSW5754
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5754
LCSW
OR
Enumeration date
08/27/2013
Last updated
08/27/2013
Update your record
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