Individual
GUNNAR ROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
75 NIELSON STREET, WATSONVILLE, CA 95076
(408) 724-4741
Mailing address
4355 GLADYS AVE, SANTA CRUZ, CA 95062-4509
(831) 462-9585
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA12560
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA16537
—
CA
Enumeration date
07/03/2006
Last updated
12/03/2008
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