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General NPI Number Information
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NPI Number | 1770893117
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Entity Type | Individual
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Provider Name | JOSE LUIS GONZALEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/19/2010
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 3800 KILROY AIRPORT WAY STE 100
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City | LONG BEACH
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State | CA
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Zip | 90806-6818
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Country | US
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Telephone | 231-669-6453
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 31309
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City | LOS ANGELES
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State | CA
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Zip | 90031-0309
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Country | US
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Telephone | 323-442-5100
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Fax |
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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 | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number | A114052
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A114052
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License Number State | CA
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