Healthcare Provider Details

I. General information

NPI: 1922254093
Provider Name (Legal Business Name): JULIE GORSHE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 EMELINE AVE
SANTA CRUZ CA
95060-1966
US

IV. Provider business mailing address

1080 EMELINE AVE
SANTA CRUZ CA
95060-1966
US

V. Phone/Fax

Practice location:
  • Phone: 831-454-5401
  • Fax:
Mailing address:
  • Phone: 831-454-4100
  • Fax: 831-454-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number19833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: