Healthcare Provider Details

I. General information

NPI: 1043213705
Provider Name (Legal Business Name): TAMMY LEE GONZALEZ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 G STREET
REEDLEY CA
93654
US

IV. Provider business mailing address

925 G STREET
REEDLEY CA
93654
US

V. Phone/Fax

Practice location:
  • Phone: 559-637-2455
  • Fax:
Mailing address:
  • Phone: 559-637-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16497
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: