MEDICARE: RACHAEL E GONZALEZ M.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	207Q00000X	Family Medicine Physician	73124	CA
2	208D00000X	General Practice Physician	MD0003235	WA

General Provider Information

NPI Number	:	1679663413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHAEL E GONZALEZ M.D.

Provider Business Mailing Address
First Line	:	2739 CLYDE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-2409
Country	:	US
Telephone Number	:	425-306-2216
Fax Number	:	323-305-7149

Provider Business Practice Location Address
First Line	:	2739 CLYDE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-2409
Country	:	US
Telephone Number	:	425-306-2216
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	09/28/2020

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