Individual
MS. LISA GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
118 S COLLEGE ST, LA HABRA, CA 90631-5503
(562) 256-7550
Mailing address
118 S COLLEGE ST, LA HABRA, CA 90631-5503
(562) 256-7550
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
576
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
576
—
CA
Enumeration date
12/28/2011
Last updated
12/28/2011
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