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NPI Code Detail

MEDICARE: JENNILYN GONZALES

MEDICARE: JENNILYN GONZALES
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
1225X00000XOccupational Therapist19472CA

General Provider Information

NPI Number : 1699313247
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNILYN GONZALES
Provider Business Mailing Address
First Line : 5758 NATICK AVE
Second Line :
City : VAN NUYS
State : CA
Zip : 91411-3323
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5400 FOUNTAIN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90029-1007
Country : US
Telephone Number : 323-461-4301
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2019
Last Update Date : 12/13/2019

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Directions to “ JENNILYN GONZALES ” Practice Location

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