Healthcare Provider Details

I. General information

NPI: 1548411689
Provider Name (Legal Business Name): MARIA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E 4TH ST STE 200
SANTA ANA CA
92705
US

IV. Provider business mailing address

2001 E 4TH ST STE 200
SANTA ANA CA
92705-3916
US

V. Phone/Fax

Practice location:
  • Phone: 714-824-8140
  • Fax: 714-824-8141
Mailing address:
  • Phone: 714-824-8140
  • Fax: 714-824-8142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: