Provider Demographics
NPI:1346265873
Name:GONZALEZ, LUIS A (DC)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 FIGUEROA ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-2300
Mailing Address - Country:US
Mailing Address - Phone:310-830-0863
Mailing Address - Fax:310-830-6969
Practice Address - Street 1:803 FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-2300
Practice Address - Country:US
Practice Address - Phone:310-830-0863
Practice Address - Fax:310-830-6969
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29860111NS0005X
CADC29860111N00000X
CA998706111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner