Healthcare Provider Details

I. General information

NPI: 1649133083
Provider Name (Legal Business Name): NATALY GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 S ATLANTIC BLVD
LOS ANGELES CA
90022-2621
US

IV. Provider business mailing address

1271 S MCDONNELL AVE
LOS ANGELES CA
90022-2933
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-9191
  • Fax:
Mailing address:
  • Phone: 323-268-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number755759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: