Provider Demographics
NPI:1770091589
Name:GONZALEZ, EFRAIN (MED, BCBA)
Entity type:Individual
Prefix:
First Name:EFRAIN
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 E 20TH ST UNIT 10
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-1059
Mailing Address - Country:US
Mailing Address - Phone:562-569-5171
Mailing Address - Fax:
Practice Address - Street 1:1230 ROSECRANS AVE STE 250
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2496
Practice Address - Country:US
Practice Address - Phone:310-406-1500
Practice Address - Fax:310-725-8069
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst