Healthcare Provider Details

I. General information

NPI: 1932062510
Provider Name (Legal Business Name): ISMAEL LUIS GONZALEZ APONTE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CONCORD AVE STE 185
CONCORD CA
94520-5006
US

IV. Provider business mailing address

792 CROXDALE ST
HORIZON CITY TX
79928-8010
US

V. Phone/Fax

Practice location:
  • Phone: 808-341-6649
  • Fax:
Mailing address:
  • Phone: 808-341-6649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: