Provider Demographics
NPI:1316161664
Name:GONZALEZ, LETICIA KEUSAYAN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LETICIA
Middle Name:KEUSAYAN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:7643 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:CA
Mailing Address - Zip Code:90201-5019
Mailing Address - Country:US
Mailing Address - Phone:323-771-1713
Mailing Address - Fax:323-562-1302
Practice Address - Street 1:7643 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:CA
Practice Address - Zip Code:90201-5019
Practice Address - Country:US
Practice Address - Phone:323-771-1713
Practice Address - Fax:323-562-1302
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2019-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA14033363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant