Healthcare Provider Details

I. General information

NPI: 1114947447
Provider Name (Legal Business Name): PEDRO GONZALEZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 N EASTERN AVE
LOS ANGELES CA
90032-1931
US

IV. Provider business mailing address

2212 GATES ST
LOS ANGELES CA
90031-2906
US

V. Phone/Fax

Practice location:
  • Phone: 323-225-2351
  • Fax: 323-225-7555
Mailing address:
  • Phone: 323-343-9303
  • Fax: 323-225-7555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-C 16154
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: