Provider Demographics
NPI:1528382066
Name:GONZALEZ, CLAUDIA (PA-C)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
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 1:1334 MANZANITA DR
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-6168
Mailing Address - Country:US
Mailing Address - Phone:760-562-6486
Mailing Address - Fax:760-357-0817
Practice Address - Street 1:495 E BIRCH ST STE A
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-2374
Practice Address - Country:US
Practice Address - Phone:760-357-0508
Practice Address - Fax:760-357-0817
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 20875363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical