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Individual
TAMMY LEE GONZALEZ
Active
Individual
TAMMY LEE GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA16497
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0085540
—
CA
05
—
GR0085541
—
CA
Enumeration date
05/24/2005
Last updated
06/14/2019
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