Provider Demographics
NPI:1851646079
Name:GONZALEZ, FAUSTO E (LAC)
Entity Type:Individual
Prefix:
First Name:FAUSTO
Middle Name:E
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 PARAMOUNT BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3317
Mailing Address - Country:US
Mailing Address - Phone:562-904-3100
Mailing Address - Fax:
Practice Address - Street 1:10800 PARAMOUNT BLVD STE 201
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3317
Practice Address - Country:US
Practice Address - Phone:562-904-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-14
Last Update Date:2012-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 14734171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist