Provider Demographics
NPI:1497099360
Name:GONZALES, LEANNA NICOLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LEANNA
Middle Name:NICOLE
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:3445 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3445 PACIFIC COAST HWY
Practice Address - Street 2:SUITE 310
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6658
Practice Address - Country:US
Practice Address - Phone:310-602-5005
Practice Address - Fax:310-373-7895
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA22555363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant