Provider Demographics
NPI:1891263752
Name:GONZALEZ, SAMANTHA (PA-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:CAZARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SAMANTHA CAZARES
Mailing Address - Street 1:PO BOX 5068
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85376-5068
Mailing Address - Country:US
Mailing Address - Phone:623-777-4747
Mailing Address - Fax:
Practice Address - Street 1:13203 N 103RD AVE STE H5
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3032
Practice Address - Country:US
Practice Address - Phone:623-777-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7209363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant