MEDICARE: MR. GERMAN OVIDIO 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	3416L0300X	Land Ambulance	1876	CA

General Provider Information

NPI Number	:	1609884170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GERMAN OVIDIO GONZALEZ

Provider Business Mailing Address
First Line	:	4634 ESPARTO ST
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-5310
Country	:	US
Telephone Number	:	213-923-9842
Fax Number	:

Provider Business Practice Location Address
First Line	:	4634 ESPARTO ST
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-5310
Country	:	US
Telephone Number	:	213-923-9842
Fax Number	:

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/08/2007

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