Individual
GASTON JEREMIAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
1310 W STEWART DR STE 503, ORANGE, CA 92868-3856
(714) 997-2224
(714) 997-1187
Mailing address
820 SUNGROVE PL, BREA, CA 92821-4130
(646) 299-2402
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
3746
CT
363AS0400X
Surgical Physician Assistant
3746
CT
363AS0400X
Surgical Physician Assistant
Primary
55591
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1131297
NPPES
CA
01
—
55591
PA
CA
Enumeration date
07/16/2016
Last updated
06/21/2024
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