Octavio Gonzalez, MD

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

A69063 Issued in CA

Practice address

29409 S Western Ave
Rancho Palos Verdes, CA 90275-1137

Phone

(424) 265-8678

Fax

(888) 847-2037

NPI assigned

Aug 5, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423267200000",
    "number": "1932390069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3062",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905103062",
            "telephone_number": "424-265-8678",
            "fax_number": "888-847-2037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29409 S WESTERN AVE",
            "city": "RANCHO PALOS VERDES",
            "state": "CA",
            "postal_code": "902751137",
            "telephone_number": "424-265-8678",
            "fax_number": "888-847-2037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "OCTAVIO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-05",
        "last_updated": "2015-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "CA",
            "license": "A69063",
            "primary": true
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "TX",
            "license": "N3682",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "HD219A",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Lurana L Graham, PH.D., LCSW
• Julie Lim Greif, L.AC , PHD

• Sports Medicine (Orthopaedic Surgery) Physician in Rancho Palos Verdes, CA
• Providers in Rancho Palos Verdes, CA by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.