Provider Demographics
NPI:1427238138
Name:GONZALES, ANTHONY DAVID (PA-C)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:DAVID
Last Name:GONZALES
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:31720 US HIGHWAY 79 S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-5895
Mailing Address - Country:US
Mailing Address - Phone:951-303-2277
Mailing Address - Fax:951-303-6432
Practice Address - Street 1:31720 US HIGHWAY 79 S
Practice Address - Street 2:SUITE 100
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-5895
Practice Address - Country:US
Practice Address - Phone:951-303-2277
Practice Address - Fax:951-303-6432
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2015-10-06
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Provider Licenses
StateLicense IDTaxonomies
CAPA19466363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical