Individual
JENNILYN GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5400 FOUNTAIN AVE, LOS ANGELES, CA 90029-1007
(323) 461-4301
Mailing address
5758 NATICK AVE, VAN NUYS, CA 91411-3323
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
19472
CA
Other
Enumeration date
12/13/2019
Last updated
12/13/2019
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