Provider Demographics
NPI:1205921947
Name:GONZALEZ, JOSEPH FELIX (RECREATION THERAPIST)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:FELIX
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:RECREATION THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 WEST LINCOLN AVENUE
Mailing Address - Street 2:#310
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6277
Mailing Address - Country:US
Mailing Address - Phone:171-476-1143
Mailing Address - Fax:
Practice Address - Street 1:5901 E 7TH STREET
Practice Address - Street 2:(116A2)
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90822-5201
Practice Address - Country:US
Practice Address - Phone:156-282-6560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41940282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital