Provider Demographics
NPI:1699164301
Name:DUENAS-GONZALEZ, DIEGO TOMAS
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:TOMAS
Last Name:DUENAS-GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15518 PIUMA AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-5350
Mailing Address - Country:US
Mailing Address - Phone:323-206-1485
Mailing Address - Fax:
Practice Address - Street 1:15518 PIUMA AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-5350
Practice Address - Country:US
Practice Address - Phone:323-206-1485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9270225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant