Healthcare Provider Details

I. General information

NPI: 1609719236
Provider Name (Legal Business Name): PATRICIA LORRAINE GONZALES OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17800 US HIGHWAY 18
APPLE VALLEY CA
92307-1221
US

IV. Provider business mailing address

22726 PAPAGO RD
APPLE VALLEY CA
92307-1133
US

V. Phone/Fax

Practice location:
  • Phone: 760-646-8000
  • Fax:
Mailing address:
  • Phone: 760-220-8852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: