Active NPI
Marshall Gonzalo
- Community Health Worker
- Oakland, CA
National Provider Identifier
1659127785
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 0136
- Practice address
- 954 60TH St Ste 10
Oakland, CA 94608-2369 - Phone
- (510) 835-2505
- Fax
- (510) 835-1062
- NPI assigned
- Apr 29, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 0136 | CA | Primary |
Addresses
Primary practice location
954 60TH St Ste 10
Oakland, CA 94608-2369
Mailing address
954 60TH St Ste 10
Oakland, CA 94608-2369
Phone (510) 835-2505
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0136 | Medicaid | CA | |
| 1722V00000X | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0136 | CA | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1714348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714348800000",
"number": "1659127785",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "954 60TH ST STE 10",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946082369",
"telephone_number": "510-835-2505",
"fax_number": "510-835-1062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "954 60TH ST STE 10",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946082369",
"telephone_number": "510-835-2505",
"fax_number": "510-835-1062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALO",
"first_name": "MARSHALL",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-04-29",
"last_updated": "2024-04-29",
"certification_date": "2024-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "CA",
"license": "0136",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0136",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1722V00000X",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.