Provider Demographics
NPI:1821536160
Name:GONZALEZ, ANGEL (CMT)
Entity Type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77682 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-0478
Mailing Address - Country:US
Mailing Address - Phone:760-345-2200
Mailing Address - Fax:760-345-2210
Practice Address - Street 1:77682 COUNTRY CLUB DR
Practice Address - Street 2:SUITE G
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-0478
Practice Address - Country:US
Practice Address - Phone:760-345-2200
Practice Address - Fax:760-345-2210
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40941173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist