Basic Information
Provider Information
NPI: 1033557822
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GONZALEZ
FirstName: CRISTINA
MiddleName: ISELA
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9101 WHITTIER BLVD
Address2:  
City: PICO RIVERA
State: CA
PostalCode: 906602405
CountryCode: US
TelephoneNumber: 5628014626
FaxNumber: 5628014630
Practice Location
Address1: 9101 WHITTIER BLVD
Address2:  
City: PICO RIVERA
State: CA
PostalCode: 906602405
CountryCode: US
TelephoneNumber: 5628014626
FaxNumber: 5628014630
Other Information
ProviderEnumerationDate: 06/13/2013
LastUpdateDate: 06/13/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225400000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner 

No ID Information.


Home