MEDICARE: MRS. SHARON LEA GONZALES D.C.

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	111N00000X	Chiropractor	DC013781	CA

General Provider Information

NPI Number	:	1487738001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARON LEA GONZALES D.C.

Provider Business Mailing Address
First Line	:	2610 TICATICA DR
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-5435
Country	:	US
Telephone Number	:	626-330-0651
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 S HACIENDA BLVD
Second Line	:	SUITE 200
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-2200
Country	:	US
Telephone Number	:	626-330-0651
Fax Number	:

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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