Provider Demographics
NPI:1497043483
Name:GONZALEZ, ALEX (PA)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:ALEJANDRO
Other - Middle Name:
Other - Last Name:GONZALEZ-SANCHEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:1160 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-3710
Practice Address - Country:US
Practice Address - Phone:916-865-1000
Practice Address - Fax:916-865-1005
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21628363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant