| Doctor Name: | MR. SAMUEL GONZALES |
| NPI Number: | 1023140670 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | BA |
| License Number: | |
| Business Practice Address: | 3200 Motor Ave Los Angeles, CA - 900343710 |
| Business Phone Number: | 3108361223 |
| Business Fax Number: | 3108376647 |
| Mailing Address: | 1201 N Crescent Heights Blvd, #105 WEST HOLLYWOOD |
| State: | CA |
| Postal Code: | 900465046 |
| Phone Number: | 3108361223 |
| Fax Number: | 3108376647 |
| NPI Enumeration Date: | 03/09/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225400000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Rehabilitation Practitioner |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity. |