Healthcare Provider Details

I. General information

NPI: 1285296657
Provider Name (Legal Business Name): MICHAEL JOSE GONZALES DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date: 06/15/2026
Reactivation Date: 07/29/2026

III. Provider practice location address

4515 OCEAN VIEW BLVD STE 350
LA CANADA FLINTRIDGE CA
91011-1409
US

IV. Provider business mailing address

224 W TERRACE ST
ALTADENA CA
91001-4706
US

V. Phone/Fax

Practice location:
  • Phone: 818-369-7620
  • Fax: 818-369-7621
Mailing address:
  • Phone: 847-736-5183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number296722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: