Healthcare Provider Details

I. General information

NPI: 1154509305
Provider Name (Legal Business Name): PAUL JOE GILARDONE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 WEST CENTRAL AVENUE SUITE G
LOMPOC CA
93436-2830
US

IV. Provider business mailing address

217 W CENTRAL AVE STE G
LOMPOC CA
93436-2830
US

V. Phone/Fax

Practice location:
  • Phone: 805-735-4292
  • Fax: 805-735-4293
Mailing address:
  • Phone: 805-735-4292
  • Fax: 805-735-4293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12836
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierCB241918
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerMEDICARE ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: