Provider Demographics
NPI:1700025574
Name:GONZALES, SEBASTIAN ANDREW III (DC)
Entity Type:Individual
Prefix:DR
First Name:SEBASTIAN
Middle Name:ANDREW
Last Name:GONZALES
Suffix:III
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 1:1525 MESA VERDE DR E
Mailing Address - Street 2:STE 108
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5221
Mailing Address - Country:US
Mailing Address - Phone:714-502-4243
Mailing Address - Fax:
Practice Address - Street 1:514 W KATELLA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867
Practice Address - Country:US
Practice Address - Phone:714-392-6482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor