Healthcare Provider Details

I. General information

NPI: 1467759043
Provider Name (Legal Business Name): JOSEPH DAVID GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 W SUNSET BLVD FL 4
LOS ANGELES CA
90027-6082
US

IV. Provider business mailing address

1340 1/2 N EDGEMONT ST
LOS ANGELES CA
90027-5912
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-8813
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA 115813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: