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General NPI Number Information
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NPI Number | 1124871801
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Entity Type | Individual
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Provider Name | VIRIDIANA SIMONA VAN DEN HENGEL-GOMEZ PA65426
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Gender | Female
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Dates
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Enumeration Date | 04/10/2024
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Last Update Date | 11/02/2025
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Provider Practice Location Address
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Address Line | 172 E GRANT AVE
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City | WINTERS
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State | CA
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Zip | 95694-1780
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Country | US
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Telephone | 916-734-2145
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Fax | 530-795-3054
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Provider Business Mailing Address
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Address Line | 224 RALEIGH DR
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City | VACAVILLE
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State | CA
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Zip | 95687-6636
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Country | US
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Telephone | 530-787-3454
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Fax | 530-795-3054
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA65426
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License Number State | CA
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