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General NPI Number Information
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NPI Number | 1679350896
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Entity Type | Individual
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Provider Name | ELIDA GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 09/11/2023
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 1500 PALMA DR STE 187
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City | VENTURA
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State | CA
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Zip | 93003-6451
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Country | US
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Telephone | 805-222-5803
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6542
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City | SANTA MARIA
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State | CA
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Zip | 93456-6542
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Country | US
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Telephone | 605-714-7515
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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 | PA63747
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License Number State | CA
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