Provider Demographics
NPI:1679007280
Name:GONZALEZ, ANGEL ALEJANDRO
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:ALEJANDRO
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 1:2402 ALICE RODRIGUEZ CIR
Mailing Address - Street 2:
Mailing Address - City:IRWINDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-3902
Mailing Address - Country:US
Mailing Address - Phone:818-822-8456
Mailing Address - Fax:
Practice Address - Street 1:1000 S FREMONT AVE UNIT 60
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-8886
Practice Address - Country:US
Practice Address - Phone:626-607-6995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst