1568510576 NPI number — GONZALEZ PHARMACY

Table of content: CYNTHIA LUNGSTRUM MSW, LCSW (NPI 1427129881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568510576 NPI number — GONZALEZ PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GONZALEZ PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1568510576
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1240 N HACIENDA BLVD
Provider Second Line Business Mailing Address:
STE 105
Provider Business Mailing Address City Name:
LA PUENTE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91744-1662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1240 N HACIENDA BLVD
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
LA PUENTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91744-1662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-221-2103
Provider Business Practice Location Address Fax Number:
626-918-4500
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KAISHAR
Authorized Official First Name:
GABRIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER PIC
Authorized Official Telephone Number:
626-221-2103

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  PHY48213 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336M0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5625061 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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