Provider Demographics
NPI:1962108936
Name:GONZALEZ, ELIZABETH DENISE (CMT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DENISE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:DENISE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:540 EVERGREEN ST APT 21
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-7135
Mailing Address - Country:US
Mailing Address - Phone:323-533-0758
Mailing Address - Fax:
Practice Address - Street 1:540 EVERGREEN ST APT 21
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-7135
Practice Address - Country:US
Practice Address - Phone:323-533-0758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37024225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist