Individual
CARISSA ANDRADE GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16955 VANOWEN ST, VAN NUYS, CA 91406-4542
(818) 343-0700
Mailing address
18560 VANOWEN ST UNIT 30, RESEDA, CA 91335-5303
(747) 998-7677
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
17728
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W250885299
AETNA
CA
Enumeration date
03/14/2019
Last updated
03/14/2019
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