Provider Demographics
NPI:1811919962
Name:GONZALES, RACHEL CAZARES (PA)
Entity type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:CAZARES
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12417 FAIR OAKS BLVD
Mailing Address - Street 2:STE 600
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-2500
Mailing Address - Country:US
Mailing Address - Phone:530-889-2013
Mailing Address - Fax:
Practice Address - Street 1:3840 WATT AVE BLDG E
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2640
Practice Address - Country:US
Practice Address - Phone:916-488-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14343363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S67890Medicare UPIN
CA0PA143436Medicare PIN