Individual
DR. OCTAVIO GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
29409 S WESTERN AVE, RANCHO PALOS VERDES, CA 90275-1137
(424) 265-8678
(888) 847-2037
Mailing address
PO BOX 3062, TORRANCE, CA 90510-3062
(424) 265-8678
(888) 847-2037
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
A69063
CA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
N3682
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HD219A
PTAN
—
Enumeration date
08/05/2007
Last updated
02/07/2015
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