MEDICARE: DAVID N. 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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1588998785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID N. GONZALEZ

Provider Business Mailing Address
First Line	:	214 E IMPERIAL HWY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90061-2544
Country	:	US
Telephone Number	:	347-248-6896
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 E IMPERIAL HWY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90061-2544
Country	:	US
Telephone Number	:	347-248-6896
Fax Number	:

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

Provider Enumeration Date	:	09/22/2009
Last Update Date	:	09/25/2009

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