Healthcare Provider Details

I. General information

NPI: 1073470043
Provider Name (Legal Business Name): JOSE MERCED GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SEA HAWK WAY
REDONDO BEACH CA
90277-2976
US

IV. Provider business mailing address

1 SEA HAWK WAY
REDONDO BEACH CA
90277-2976
US

V. Phone/Fax

Practice location:
  • Phone: 310-798-8665
  • Fax:
Mailing address:
  • Phone: 310-798-8665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number210192161
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: