Provider Demographics
NPI:1275868259
Name:GORGA, MARI (PA-C)
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:
Last Name:GORGA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2950 BUSKIRK AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-6900
Mailing Address - Country:US
Mailing Address - Phone:888-380-0988
Mailing Address - Fax:289-236-3022
Practice Address - Street 1:430 WILLOW ST
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-6130
Practice Address - Country:US
Practice Address - Phone:888-380-0988
Practice Address - Fax:833-992-2313
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2022-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601005621363A00000X
CA61622363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant