Provider Demographics
NPI:1982134243
Name:GONZALES, RICHARD ALAN (MS, OTR/L)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ALAN
Last Name:GONZALES
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Gender:M
Credentials:MS, OTR/L
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Mailing Address - Street 1:13636 VENTURA BLVD C/O OTOL RX
Mailing Address - Street 2:#420
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3700
Mailing Address - Country:US
Mailing Address - Phone:818-763-9997
Mailing Address - Fax:818-763-9979
Practice Address - Street 1:13636 VENTURA BLVD C/O OTOL RX
Practice Address - Street 2:#420
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-3700
Practice Address - Country:US
Practice Address - Phone:818-763-9997
Practice Address - Fax:818-763-9979
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
CAOT4716225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist