Individual
CASSIDY ELAINE GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
116 N 700 E, PROVO, UT 84606-3321
(435) 770-2898
Mailing address
116 N 700 E, PROVO, UT 84606-3321
(435) 770-2898
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
124608261206
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/06/2021
Last updated
09/16/2021
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