MEDICARE: PATRICIA GONZALEZ CM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NONE	OTHER	CA	CASE MANAGER

General Provider Information

NPI Number	:	1194866756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA GONZALEZ CM

Provider Business Mailing Address
First Line	:	520 S LA FAYETTE PARK PL FL 3
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-1607
Country	:	US
Telephone Number	:	213-252-2100
Fax Number	:	213-383-3146

Provider Business Practice Location Address
First Line	:	520 S LA FAYETTE PARK PL FL 3
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-1607
Country	:	US
Telephone Number	:	213-252-2100
Fax Number	:	213-383-3146

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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