Individual
JAN GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
36 MAUCHLY STE A, IRVINE, CA 92618-2390
(949) 727-3315
(949) 727-3624
Mailing address
18726 S WESTERN AVE STE 408, GARDENA, CA 90248-3858
(310) 856-0800
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
224Z00000X
Occupational Therapy Assistant
Primary
6577
CA
Other
Enumeration date
04/22/2021
Last updated
10/05/2023
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