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NPI Code Detail

MEDICARE: ROSSELY GONZALEZ MBA

MEDICARE: ROSSELY GONZALEZ MBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1373H00000XDay Training/Habilitation Specialist

General Provider Information

NPI Number : 1194811232
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROSSELY GONZALEZ MBA
Provider Business Mailing Address
First Line : 2021 ILLINOIS ST
Second Line :
City : WEST COVINA
State : CA
Zip : 91792-2454
Country : US
Telephone Number : 714-226-9888
Fax Number :
Provider Business Practice Location Address
First Line : 2569 W WOODLAND DR
Second Line :
City : ANAHEIM
State : CA
Zip : 92801-2608
Country : US
Telephone Number : 714-226-9888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2006
Last Update Date : 07/08/2007

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