Healthcare Provider Details

I. General information

NPI: 1801773668
Provider Name (Legal Business Name): CARMI GONZALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 E DEL MAR BLVD STE 2
PASADENA CA
91107-4322
US

IV. Provider business mailing address

28217 HOT SPRINGS AVE
CANYON COUNTRY CA
91351-1143
US

V. Phone/Fax

Practice location:
  • Phone: 626-639-8624
  • Fax:
Mailing address:
  • Phone: 818-209-8002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: