Healthcare Provider Details

I. General information

NPI: 1003189895
Provider Name (Legal Business Name): JOSEPH CHARLES GONZALES ORDONA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S LAKE AVE SUITE 280
PASADENA CA
91101-3530
US

IV. Provider business mailing address

813 ALPINE ST APT 315
LOS ANGELES CA
90012-6410
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-8314
  • Fax: 626-449-6915
Mailing address:
  • Phone: 310-592-0529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number31986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: