Provider Demographics
NPI:1497304422
Name:GONZALEZ, GABRIEL JESUS
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:JESUS
Last Name: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 1:1837 FRUITVALE AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-4103
Mailing Address - Country:US
Mailing Address - Phone:909-883-5069
Mailing Address - Fax:909-783-4288
Practice Address - Street 1:12139 MOUNT VERNON AVE STE 110
Practice Address - Street 2:
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-5500
Practice Address - Country:US
Practice Address - Phone:909-883-5069
Practice Address - Fax:909-783-4288
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist