Provider Demographics
NPI:1841824224
Name:JOHNSON-GONZALES, MARIA DELALUZ (OT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DELALUZ
Last Name:JOHNSON-GONZALES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12431 CONCORD CT
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2235
Mailing Address - Country:US
Mailing Address - Phone:626-488-4966
Mailing Address - Fax:
Practice Address - Street 1:14837 PEYTON DR
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-2075
Practice Address - Country:US
Practice Address - Phone:909-538-8642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT4141225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA