Healthcare Provider Details

I. General information

NPI: 1699096990
Provider Name (Legal Business Name): ERIK GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 AVENUE 64
PASADENA CA
91105-2711
US

IV. Provider business mailing address

1911 WILLIAMS DR. VENTURA COUNTY BEH HEALTH
OXNARD CA
93036
US

V. Phone/Fax

Practice location:
  • Phone: 323-254-2274
  • Fax: 323-254-2274
Mailing address:
  • Phone: 85-276-7685
  • Fax: 805-981-4291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: