MEDICARE: MR. MICHAEL GONZALEZ L.AC.

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
1	171100000X	Acupuncturist	AC10916	CA

General Provider Information

NPI Number	:	1821276692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL GONZALEZ L.AC.

Provider Business Mailing Address
First Line	:	6424 COLDWATER CANYON AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-1113
Country	:	US
Telephone Number	:	818-787-1492
Fax Number	:

Provider Business Practice Location Address
First Line	:	6424 COLDWATER CANYON AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-1113
Country	:	US
Telephone Number	:	818-787-1492
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2008
Last Update Date	:	02/08/2012

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