Provider Demographics
NPI:1780228338
Name:GONZALEZ, LAURA (DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24422 AVENIDA DE LA CARLOTA STE 190
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3634
Mailing Address - Country:US
Mailing Address - Phone:949-340-6927
Mailing Address - Fax:
Practice Address - Street 1:24422 AVENIDA DE LA CARLOTA STE 190
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3634
Practice Address - Country:US
Practice Address - Phone:949-340-6927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT297571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist