Healthcare Provider Details

I. General information

NPI: 1114521929
Provider Name (Legal Business Name): SALVADOR GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 N BROADWAY
LOS ANGELES CA
90031-2803
US

IV. Provider business mailing address

6030 ROY ST
LOS ANGELES CA
90042-2056
US

V. Phone/Fax

Practice location:
  • Phone: 323-244-0068
  • Fax:
Mailing address:
  • Phone: 323-432-4399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: