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General NPI Number Information
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NPI Number | 1588850812
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Entity Type | Individual
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Provider Name | GLADYS JOANA GONZALES P.A -C
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Gender | Female
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 09/20/2007
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Provider Practice Location Address
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Address Line | 2273 E GALA ST SUITE 100
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City | MERIDIAN
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State | ID
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Zip | 83642-7289
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Country | US
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Telephone | 208-898-8999
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Fax |
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Provider Business Mailing Address
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Address Line | 2273 E GALA ST SUITE 100
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City | MERIDIAN
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State | ID
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Zip | 83642-7289
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Country | US
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Telephone | 208-898-8999
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-694
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License Number State | ID
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