Provider Demographics
NPI:1760436372
Name:GONZALES, ALICJA KATARZYNA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:ALICJA
Middle Name:KATARZYNA
Last Name:GONZALES
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Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:3600 NW JOHN OLSEN PL
Mailing Address - Street 2:SUITE 250
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5815
Mailing Address - Country:US
Mailing Address - Phone:503-684-8252
Mailing Address - Fax:186-685-9819
Practice Address - Street 1:202 NW 13TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2953
Practice Address - Country:US
Practice Address - Phone:503-408-4078
Practice Address - Fax:186-685-9819
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2009-07-02
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Provider Licenses
StateLicense IDTaxonomies
ORPA01067363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORQ58299Medicare UPIN
OR133396Medicare PIN