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General NPI Number Information
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NPI Number | 1447460472
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Entity Type | Individual
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Provider Name | MAYLIN GONZALEZ O.D.
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Gender | Female
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 12222 WILSHIRE BLVD. SUITE 105
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City | LOS ANGELES
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State | CA
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Zip | 90025
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Country | US
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Telephone | 424-208-3107
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Fax | 424-208-3065
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Provider Business Mailing Address
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Address Line | 1150 18TH ST STE 103
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City | SANTA MONICA
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State | CA
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Zip | 90403-5600
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Country | US
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Telephone | 424-208-3107
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Fax | 424-208-3065
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 14297
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License Number State | CA
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