Healthcare Provider Details

I. General information

NPI: 1780188631
Provider Name (Legal Business Name): HECTOR DUENAS GONZALEZ, O.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2524 S FIGUEROA ST
LOS ANGELES CA
90007-2549
US

IV. Provider business mailing address

2524 S FIGUEROA ST
LOS ANGELES CA
90007-2549
US

V. Phone/Fax

Practice location:
  • Phone: 213-749-3888
  • Fax: 213-747-8670
Mailing address:
  • Phone: 213-749-3888
  • Fax: 213-747-8670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14450
License Number StateCA

VIII. Authorized Official

Name: DR. HECTOR DUENAS GONZALEZ
Title or Position: PRESIDENT
Credential: O.D.
Phone: 323-683-2285