Provider Demographics
NPI:1780059782
Name:GONZALES, JHINELLE (COTA/L)
Entity type:Individual
Prefix:
First Name:JHINELLE
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 TAGUS ST
Mailing Address - Street 2:UNIT 26
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-1463
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8135 PAINTER AVE
Practice Address - Street 2:UNIT 201
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-3158
Practice Address - Country:US
Practice Address - Phone:562-698-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA3379224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant