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General NPI Number Information
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NPI Number | 1285230490
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Entity Type | Individual
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Provider Name | MICHAEL GONZALEZ PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/11/2020
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Last Update Date | 07/12/2024
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Provider Practice Location Address
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Address Line | 10538 MISSION GORGE RD STE 100
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City | SANTEE
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State | CA
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Zip | 92071-3154
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Country | US
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Telephone | 619-456-0033
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Fax |
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Provider Business Mailing Address
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Address Line | 3643 BOUNDARY ST
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City | SAN DIEGO
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State | CA
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Zip | 92104-3805
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Country | US
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Telephone |
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Fax |
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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 | 59124
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License Number State | CA
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