Provider Demographics
NPI:1598352379
Name:GONZALEZ, CHARLES RYAN
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:RYAN
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 1:27714 SYCAMORE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1330
Mailing Address - Country:US
Mailing Address - Phone:661-993-2755
Mailing Address - Fax:
Practice Address - Street 1:27714 SYCAMORE CREEK DR
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91354-1330
Practice Address - Country:US
Practice Address - Phone:661-993-2755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAP37446146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic