Individual
LIONEL MADRID GONZALES JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1310 W STEWART DR, SUITE 503, ORANGE, CA 92868-3854
(714) 997-2224
(714) 997-1187
Mailing address
1310 W. STEWART DRIVE, SUITE 503, ORANGE, CA 92868-3856
(714) 997-2224
(714) 997-1187
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA10115
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA10115
STATE LICENSE
CA
Enumeration date
07/10/2006
Last updated
07/08/2007
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