Provider Demographics
NPI:1730327933
Name:GALES, MICHAEL LEE (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:GALES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27829 PALMETTO RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1314
Mailing Address - Country:US
Mailing Address - Phone:661-297-1213
Mailing Address - Fax:
Practice Address - Street 1:27829 PALMETTO RIDGE DR
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91354-1314
Practice Address - Country:US
Practice Address - Phone:661-297-1213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11119363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical