Healthcare Provider Details

I. General information

NPI: 1194866756
Provider Name (Legal Business Name): PATRICIA GONZALEZ CM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S LA FAYETTE PARK PL FL 3
LOS ANGELES CA
90057-1607
US

IV. Provider business mailing address

520 S LA FAYETTE PARK PL FL 3
LOS ANGELES CA
90057-1607
US

V. Phone/Fax

Practice location:
  • Phone: 213-252-2100
  • Fax: 213-383-3146
Mailing address:
  • Phone: 213-252-2100
  • Fax: 213-383-3146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: