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General NPI Number Information
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NPI Number | 1811233984
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Entity Type | Organization
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Legal Business Name | MAYLIN GONZALEZ OD AN OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 12/18/2012
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Last Update Date | 12/18/2012
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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 | 90025-1173
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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 | 12222 WILSHIRE BLVD SUITE 105
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City | LOS ANGELES
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State | CA
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Zip | 90025-1173
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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 | PRESIDENT/OWNER
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Name | DR. MAYLIN GONZALEZ
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Credential | O.D.
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Telephone | 424-208-3107
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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 |
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License Number State |
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