Provider Demographics
NPI:1609884170
Name:GONZALEZ, GERMAN OVIDIO
Entity Type:Individual
Prefix:MR
First Name:GERMAN
Middle Name:OVIDIO
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 1:4634 ESPARTO ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-5310
Mailing Address - Country:US
Mailing Address - Phone:213-923-9842
Mailing Address - Fax:
Practice Address - Street 1:4634 ESPARTO ST
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-5310
Practice Address - Country:US
Practice Address - Phone:213-923-9842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18763416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZ547Medicare ID - Type UnspecifiedPART B CARRIER