MEDICARE: ARTEMIO 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	19-151	CA

General Provider Information

NPI Number	:	1861916439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARTEMIO GONZALEZ

Provider Business Mailing Address
First Line	:	11900 SOUTH AVALON BLVD
Second Line	:	SUITE 200
City	:	LOS ANGELES
State	:	CA
Zip	:	90061
Country	:	US
Telephone Number	:	323-979-4264
Fax Number	:

Provider Business Practice Location Address
First Line	:	11900 AVALON BLVD STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90061-2867
Country	:	US
Telephone Number	:	323-242-0500
Fax Number	:	323-242-0600

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

Provider Enumeration Date	:	07/26/2017
Last Update Date	:	07/26/2017

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Directions to “ ARTEMIO GONZALEZ ” Practice Location

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