Individual
ENRIQUE JOSE GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
321 S MEDNIK AVE, LOS ANGELES, CA 90022
(323) 261-4706
(323) 261-4124
Mailing address
321 S MEDNIK AVE, LOS ANGELES, CA 90022-1839
(323) 261-4706
(323) 261-4124
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
G74790
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G747490
—
CA
Enumeration date
01/18/2007
Last updated
03/05/2019
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