Provider Demographics
NPI:1255183943
Name:GONZALEZ SALDIVAR, ROQUE JR
Entity type:Individual
Prefix:
First Name:ROQUE
Middle Name:
Last Name:GONZALEZ SALDIVAR
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 W 152ND ST
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-2820
Mailing Address - Country:US
Mailing Address - Phone:310-527-1083
Mailing Address - Fax:
Practice Address - Street 1:3525 PACIFIC COAST HWY STE N
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6657
Practice Address - Country:US
Practice Address - Phone:310-534-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5846237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist