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General NPI Number Information
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NPI Number | 1487927331
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Entity Type | Organization
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Legal Business Name | MANUEL D GONZALEZ, O.D., INC
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Dates
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Enumeration Date | 02/22/2012
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 11552 TELEGRAPH RD
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City | SANTA FE SPRINGS
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State | CA
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Zip | 90670-3110
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Country | US
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Telephone | 562-868-2418
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Fax | 562-868-7043
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Provider Business Mailing Address
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Address Line | 11552 TELEGRAPH RD
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City | SANTA FE SPRINGS
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State | CA
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Zip | 90670-3110
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Country | US
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Telephone | 562-868-2418
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Fax | 562-868-7043
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MANUEL D GONZALEZ
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Credential | O.D.
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Telephone | 562-868-2418
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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 | 7199 TLG
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License Number State | CA
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