Provider Demographics
NPI:1629318472
Name:GONZALEZ, RICARDO F (CSA)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:F
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6998 S RIVERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-2486
Mailing Address - Country:US
Mailing Address - Phone:720-982-8927
Mailing Address - Fax:
Practice Address - Street 1:6998 S RIVERWOOD WAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-2486
Practice Address - Country:US
Practice Address - Phone:720-982-8927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
13-116OtherAMERICAN BOARD OF SURGICAL ASSISTANTS