Healthcare Provider Details

I. General information

NPI: 1023542248
Provider Name (Legal Business Name): CECILIA GONZALES LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15330 VALLEY VIEW AVE STE 1
LA MIRADA CA
90638-5238
US

IV. Provider business mailing address

7300 ALONDRA BLVD STE 101
PARAMOUNT CA
90723-4000
US

V. Phone/Fax

Practice location:
  • Phone: 562-802-0208
  • Fax: 562-802-0999
Mailing address:
  • Phone: 562-531-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA48339
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: