Individual
DR. MITZI MICHELLE GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
444 S SAN VICENTE BLVD STE 103, LOS ANGELES, CA 90048-4169
(310) 423-9722
(310) 248-8710
Mailing address
4140 W 190TH ST, TORRANCE, CA 90504-5513
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
36697
TX
103G00000X
Clinical Neuropsychologist
Primary
PSY28558
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
382200901
—
TX
01
—
382200902
CSHCN
TX
Enumeration date
04/21/2017
Last updated
12/07/2023
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