Provider Demographics
NPI:1790847150
Name:FREDELL-GONZALEZ, DEBORAH LISA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LISA
Last Name:FREDELL-GONZALEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:LISA
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1615 BUNKER HILL WAY 100
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-6010
Mailing Address - Country:US
Mailing Address - Phone:831-796-1385
Mailing Address - Fax:
Practice Address - Street 1:1441 CONSTITUTION BLVD STE 16
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3100
Practice Address - Country:US
Practice Address - Phone:480-209-9063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22943363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87703041Medicaid