Healthcare Provider Details

I. General information

NPI: 1144925496
Provider Name (Legal Business Name): MONIQUE ALEXANDRIA GONZALEZ-JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3106 W BEVERLY BLVD
MONTEBELLO CA
90640-2217
US

IV. Provider business mailing address

3106 W BEVERLY BLVD
MONTEBELLO CA
90640-2217
US

V. Phone/Fax

Practice location:
  • Phone: 323-728-1274
  • Fax: 323-720-9954
Mailing address:
  • Phone: 323-728-1274
  • Fax: 322-720-9954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA206318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: