Individual
OMAR ANTONIO GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPSS
Contact information
Practice address
840 N AVENUE 66, LOS ANGELES, CA 90042-1508
(626) 395-7100
Mailing address
840 N AVENUE 66, LOS ANGELES, CA 90042-1508
(626) 395-7100
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-SVNAQZ
CA
Other
Enumeration date
06/30/2026
Last updated
06/30/2026
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