Provider Demographics
NPI:1114947447
Name:GONZALEZ, PEDRO (PA-C)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 GATES ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-2906
Mailing Address - Country:US
Mailing Address - Phone:323-343-9303
Mailing Address - Fax:323-225-7555
Practice Address - Street 1:3301 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-1931
Practice Address - Country:US
Practice Address - Phone:323-225-2351
Practice Address - Fax:323-225-7555
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA-C 16154363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical