Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC29860 | CA |
N | 111NI0013X | Independent Medical Examiner | 998706 | CA |
N | 111NS0005X | Chiropractic Sports Physician | 29860 | CA |
NPI | 1346265873 |
---|---|
Provider Name | Luis A Gonzalez |
First Address | Wilmington, CA 90744-2300 |
Second Address | Wilmington, CA 90744-2300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 08/01/2009 |