Individual
MR. CARLOS GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT.
Contact information
Practice address
754 N MOUNTAIN AVE, ONTARIO, CA 91762-2544
(909) 460-4155
(909) 988-4414
Mailing address
16702 VALLEY VIEW, LA MIRADA, CA 90638
(714) 361-5360
(714) 635-5428
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT335000
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CZ965Z
MEDICARE
CA
Enumeration date
03/31/2008
Last updated
07/21/2022
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