Gabriel Jesus Gonzalez

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

297290 Issued in CA

Practice address

12139 Mount Vernon Ave Ste 110
Grand Terrace, CA 92313-5500

Phone

(909) 883-5069

Fax

(909) 783-4288

NPI assigned

Sep 11, 2019

Last updated

Dec 6, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Baldwin Park, CA
  • NPI 1770515280
  Medicare reassignment NPD
• Total Care Physical Therapy Inc.

  • Physical Therapy Clinic/Center
  • Colton, CA
  • NPI 1831441054
  Medicare reassignment NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Los Angeles, CA
  • NPI 1134151657
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1497304422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1837 FRUITVALE AVE",
            "address_2": "UNIT B",
            "city": "EL MONTE",
            "state": "CA",
            "postal_code": "917334103",
            "telephone_number": "909-883-5069",
            "fax_number": "909-783-4288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12139 MOUNT VERNON AVE STE 110",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923135500",
            "telephone_number": "909-883-5069",
            "fax_number": "909-783-4288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "GABRIEL",
        "middle_name": "JESUS",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-11",
        "last_updated": "2021-12-06",
        "certification_date": "2021-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "297290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4733 W Sunset Blvd",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900276021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gateway to Perinatal Services Foundation
• Sukhdeep K Gill, M.D.
• Chloe Gomez
• Misti Gomez
• Qiana A Gonzalez Garcia
• Jocselyn Gonzalez
• Grand Terrace Health Care, Inc. (Grand Terrace Care Center)
• Grand Terrace Modern Dentistry, Inc
• Mykell Gray
• Natalie Ann Hagan, AGACNP

• Physical Therapist in Grand Terrace, CA
• Providers in Grand Terrace, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.