Active NPI
Rocio Revuelta Gonzalez, PH.D.
- Psychologist
- Los Angeles, CA
National Provider Identifier
1740496918
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY 12043
- Practice address
- 2862 W Avenue 35
Los Angeles, CA 90065-2222 - Phone
- (323) 422-8678
- NPI assigned
- May 15, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY 12043 | CA | Primary |
| Psychologist | 103T00000X | 1803 | AZ |
Addresses
Primary practice location
2862 W Avenue 35
Los Angeles, CA 90065-2222
Mailing address
PO Box 65615
Los Angeles, CA 90065-0615
Phone (323) 422-8678
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 12043 | CA | MD | Psychologist |
| 1803 | AZ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1356048000000",
"number": "1740496918",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 65615",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900650615",
"telephone_number": "323-422-8678"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2862 W AVENUE 35",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900652222",
"telephone_number": "323-422-8678"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALEZ",
"first_name": "ROCIO",
"middle_name": "REVUELTA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-15",
"last_updated": "2012-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY 12043",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "AZ",
"license": "1803",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.