Provider Demographics
NPI:1902497316
Name:GONZALEZ, RICARDO (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 N HOLLOW AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-1547
Mailing Address - Country:US
Mailing Address - Phone:626-274-7442
Mailing Address - Fax:
Practice Address - Street 1:554 N HOLLOW AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-1547
Practice Address - Country:US
Practice Address - Phone:626-274-7442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25987225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist