Healthcare Provider Details

I. General information

NPI: 1518580919
Provider Name (Legal Business Name): JONATHAN GONZALEZ RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST # M
LOS ANGELES CA
90033-1029
US

IV. Provider business mailing address

1200 N STATE ST # M
LOS ANGELES CA
90033-1029
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-3287
  • Fax:
Mailing address:
  • Phone: 323-409-3287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number41676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: