Healthcare Provider Details

I. General information

NPI: 1790847150
Provider Name (Legal Business Name): DEBORAH LISA FREDELL-GONZALEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH LISA CHAPMAN PA-C

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD STE 16
SALINAS CA
93906-3100
US

IV. Provider business mailing address

1615 BUNKER HILL WAY 100
SALINAS CA
93906-6010
US

V. Phone/Fax

Practice location:
  • Phone: 480-209-9063
  • Fax:
Mailing address:
  • Phone: 831-796-1385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number22943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: