Individual provider Active NPI

Gonzalo Walter Wilches Jr., MA MFT

  • Social Worker
  • Tampa, FL
National Provider Identifier
1710057013
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
Practice address
5707 N 22ND Street
Mental Health Care Inc
Tampa, FL 33610
Phone
(813) 272-2878
Fax
(813) 272-3766
NPI assigned
Nov 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X Primary

Addresses

Primary practice location

5707 N 22ND Street
Mental Health Care Inc
Tampa, FL 33610

Mailing address

5707 N 22ND Street
Mental Health Care Inc
Tampa, FL 33610
Phone (813) 272-2878

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
I20240522003051 CA Practitioner - Marriage and Family Therapist 5193167120 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
46696CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PC CurrentSince Apr 10, 2024 Accepting new patients

Locations

99 Almaden Blvd
Ste 600
San Jose, CA 95113
Phone (408) 402-4385

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

Organizations & group practices 1

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": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710057013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5707 N 22ND STREET",
            "address_2": "MENTAL HEALTH CARE INC",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33610",
            "telephone_number": "813-272-2878",
            "fax_number": "813-272-3766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5707 N 22ND STREET",
            "address_2": "MENTAL HEALTH CARE INC",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33610",
            "telephone_number": "813-272-2878",
            "fax_number": "813-272-3766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILCHES",
        "first_name": "GONZALO",
        "middle_name": "WALTER",
        "name_suffix": "Jr.",
        "credential": "MA MFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.