1841824224 NPI number — MARIA DELALUZ JOHNSON-GONZALES OT

Table of content: MARIA DELALUZ JOHNSON-GONZALES OT (NPI 1841824224)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841824224 NPI number — MARIA DELALUZ JOHNSON-GONZALES OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON-GONZALES
Provider First Name:
MARIA
Provider Middle Name:
DELALUZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841824224
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12431 CONCORD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91710-2235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-488-4966
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14837 PEYTON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHINO HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91709-2075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-538-8642
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT4141 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NA . This is a "NA" identifier . This identifiers is of the category "OTHER".