Provider Demographics
NPI:1548993058
Name:GONZALEZ, YESENIA CHARLENE (PA-C)
Entity type:Individual
Prefix:MS
First Name:YESENIA
Middle Name:CHARLENE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:YESENIA
Other - Middle Name:CHARLENE
Other - Last Name:GONZALEZ-ZAVALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3727 W 6TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-5108
Mailing Address - Country:US
Mailing Address - Phone:213-235-2500
Mailing Address - Fax:
Practice Address - Street 1:3727 W 6TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-5108
Practice Address - Country:US
Practice Address - Phone:213-235-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-03
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA64592363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant