MEDICARE: DR. CHRISTINE MARIE GONZALEZ PHARM D

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	183500000X	Pharmacist	RPH 54935	CA

General Provider Information

NPI Number	:	1386632032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINE MARIE GONZALEZ PHARM D

Provider Business Mailing Address
First Line	:	1522 EUCLID ST
Second Line	:	#20
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-3329
Country	:	US
Telephone Number	:	310-451-7217
Fax Number	:	310-451-7217

Provider Business Practice Location Address
First Line	:	444 S FLOWER ST
Second Line	:	SUITE 100
City	:	LOS ANGELES
State	:	CA
Zip	:	90071-2901
Country	:	US
Telephone Number	:	213-612-4300
Fax Number	:

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

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	07/08/2007

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