Individual provider Active NPI

Maria Alejandra Gonzalez

  • Clinical Social Worker
  • Fontana, CA
National Provider Identifier
1306203336
Registry record updated Dec 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
101635 Issued in CA
Practice address
9310 Sierra Ave
Fontana, CA 92335-5711
Phone
(866) 205-3595
NPI assigned
Jan 21, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X ASW70321 CA
Rehabilitation Practitioner 225400000X
Clinical Social Worker 1041C0700X 101635 CA Primary

Addresses

Primary practice location

9310 Sierra Ave
Fontana, CA 92335-5711

Mailing address

9310 Sierra Ave
Fontana, CA 92335-5711
Phone (866) 205-3595

Other names 1

  • Maria Alejandra Hermosillo Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Kaiser Permanente

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220222000131 CA Practitioner - Clinical Social Worker 8820482656 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sud Specialty Group - CaGroup PAC ID 9537534177, 519 clinicians

Practice addresses (Care Compare)

4633 Old Ironsides Dr
Suite 304
Santa Clara, CA 95054-1846
Phone (866) 280-0260

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ASW70321CAMDMental Health Counselor
101635CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Dec 13, 2021 Accepting new patients
Southern California Permanente Medical Group CurrentSince Dec 13, 2021 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Sud Specialty Group - Ca Clinical CurrentSince Aug 1, 2025 Accepting new patients

Locations

9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910

9310 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3700

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

5201 Great America Pkwy
Ste 320
Santa Clara, CA 95054
Phone (323) 968-6182

4633 Old Ironsides Dr
Ste 304
Santa Clara, CA 95054
Phone (501) 271-9428

520 Broadway
Ste 200
Santa Monica, CA 90401
Phone (949) 280-5295

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1453334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640217600000",
    "number": "1306203336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9310 SIERRA AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923355711",
            "telephone_number": "866-205-3595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9310 SIERRA AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923355711",
            "telephone_number": "866-205-3595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "MARIA",
        "middle_name": "ALEJANDRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-21",
        "last_updated": "2021-12-23",
        "certification_date": "2021-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ASW70321",
            "primary": false
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "101635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Kaiser Permanente",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9310 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923355711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARIA",
            "last_name": "HERMOSILLO",
            "middle_name": "ALEJANDRA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fontana, CA

Sources for this page

Verify at the official NPI Registry.