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Organization
BOULEVARD MEDICAL GROUP, INC.
Active
Organization
BOULEVARD MEDICAL GROUP, INC.
Active
Other names
Prohealth Physical Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT GONZALEZ D.C. (PRESIDENT)
(818) 505-0152
Entity
Organization
Contact information
Practice address
11239 VENTURA BLVD STE 213, STUDIO CITY, CA 91604-3167
(818) 505-0152
(818) 505-0398
Mailing address
11239 VENTURA BLVD STE 213, STUDIO CITY, CA 91604-3167
(818) 505-0152
(818) 505-0398
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
09/25/2014
Last updated
10/23/2015
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