MEDICARE: JOSHUA GONZALEZ

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	172V00000X	Community Health Worker		CA

General Provider Information

NPI Number	:	1447957899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA GONZALEZ

Provider Business Mailing Address
First Line	:	1855 W KATELLA AVE
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92867-3451
Country	:	US
Telephone Number	:	714-399-3480
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 E SANTA ANA BLVD APT 214
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-4183
Country	:	US
Telephone Number	:	540-670-1003
Fax Number	:

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

Provider Enumeration Date	:	02/15/2023
Last Update Date	:	03/31/2023

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Directions to “ JOSHUA GONZALEZ ” Practice Location

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