Provider Demographics
NPI:1023458239
Name:RIOS-GASTELUM, CLAUDIA MARIA (MA)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:MARIA
Last Name:RIOS-GASTELUM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CLAUDIA
Other - Middle Name:MARIA
Other - Last Name:RIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 600994
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92160-0994
Mailing Address - Country:US
Mailing Address - Phone:858-247-1774
Mailing Address - Fax:
Practice Address - Street 1:3510 NEWTON AVE
Practice Address - Street 2:BUNGALOW 103
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-3118
Practice Address - Country:US
Practice Address - Phone:619-344-6229
Practice Address - Fax:619-344-6247
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 97284106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist