Healthcare Provider Details

I. General information

NPI: 1134878812
Provider Name (Legal Business Name): FERNANDO SEBASTIAN GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST UNIT 21, BLDG D-9
TORRANCE CA
90502
US

IV. Provider business mailing address

11607 AMESTOY AVE
GRANADA HILLS CA
91344-2527
US

V. Phone/Fax

Practice location:
  • Phone: 424-306-5428
  • Fax: 310-782-1763
Mailing address:
  • Phone: 818-322-7213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA188997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: