Provider Demographics
NPI:1588426795
Name:GONZALEZ, NAHOUL (PTA)
Entity type:Individual
Prefix:
First Name:NAHOUL
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 W ALONDRA BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4564
Mailing Address - Country:US
Mailing Address - Phone:310-486-9844
Mailing Address - Fax:
Practice Address - Street 1:8905 VENICE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3340
Practice Address - Country:US
Practice Address - Phone:424-298-8005
Practice Address - Fax:877-408-2776
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA52491225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant