MEDICARE: KISHI GONZALES

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
2	225400000X	Rehabilitation Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376072918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KISHI GONZALES

Provider Business Mailing Address
First Line	:	37643 PRENTISS AVE
Second Line	:
City	:	PALMDALE
State	:	CA
Zip	:	93550-7711
Country	:	US
Telephone Number	:	661-506-0077
Fax Number	:

Provider Business Practice Location Address
First Line	:	9517 REA AVE
Second Line	:
City	:	CALIFORNIA CITY
State	:	CA
Zip	:	93505-4831
Country	:	US
Telephone Number	:	661-506-0077
Fax Number	:

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

Provider Enumeration Date	:	06/07/2017
Last Update Date	:	04/15/2026

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Directions to “ KISHI GONZALES ” Practice Location

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