MR. OMAR J GONZALEZ (NPI# 1831412485) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831412485 |
| Entity Type | Individual |
| Full Name | MR. OMAR J GONZALEZ |
| Credential | PA-C |
| Practice Address |
4011 Talbot Rd S Suite 300 Renton WA 98055-5773 |
| Mailing Address |
9200 Se 91st Ave Ste 340 Portland OR 97086-3756 |
| Practice Telephone | 4256565060 |
| Practice Fax Number | 4256565047 |
| Mailing Telephone | 5032561462 |
| Mailing Fax Number | 5032579523 |
| Enumeration Date | 2010-03-10 |
| Last Update Date | 2018-08-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA60133734 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275796179 | Omar Gonzalez | Optometrist | 3420 W. Illinois Avenue Suite 700, Dallas, TX 75211-8722 | 2008-07-10 |
| 1780682260 | Omar Gonzalez | Internal Medicine | 1700 N Oregon St, Suite 515, El Paso, TX 79902-3584 | 2005-07-08 |
| 1942811252 | Omar Gonzalez | Social Worker | 867 N Fair Oaks Ave, Pasadena, CA 91103-3050 | 2020-08-11 |
| 1982231536 | Omar Gonzalez | Counselor | 2130 E 4th St, Santa Ana, CA 92705-3818 | 2020-03-24 |
| 1053843789 | Omar Gonzalez | Counselor | 6013 S Redwood Rd, Taylorsville, UT 84123-5220 | 2017-03-31 |
| 1952649667 | Omar Gonzalez | Counselor | 390 40th St, Oakland, CA 94609-2633 | 2013-01-30 |
| 1306180039 | Omar Gonzalez | Counselor | 6208 Seville Ave, Huntington Park, CA 90255-2913 | 2012-11-19 |
| 1659475309 | Omar Gonzalez | Emergency Medicine | 101 E Ridge Rd, Mcallen, TX 78503-1248 | 2006-09-12 |
| 1982637849 | Omar Y Gonzalez | Internal Medicine | 3330 N 2nd St, Suite 300, Phoenix, AZ 85012-2368 | 2006-07-07 |
| Street Address |
4011 TALBOT RD S SUITE 300 |
| City | RENTON |
| State | WA |
| Zip Code | 98055-5773 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528061694 | Guy V Buell | Specialist | 4011 Talbot Rd S, Ste 440, Renton, WA 98055-5791 | 2005-05-23 |
| 1649756883 | Amy Elizabeth Hardiman | Physical Therapy Assistant | 4011 Talbot Rd S, Renton, WA 98055-5773 | 2018-07-11 |
| 1336665959 | Mary Elizabeth Walton | Dietitian, Registered | 4011 Talbot Rd S, Renton, WA 98055-5773 | 2017-08-15 |
| 1548791924 | Southlake Select, PC | Point of Service | 4011 Talbot Rd S, 440, Renton, WA 98055-5773 | 2017-03-27 |
| 1871031864 | Abrey Lee | Dietitian, Registered | 4011 Talbot Rd S, Suite 100, Renton, WA 98055-5773 | 2017-02-09 |
| 1962940957 | Kimberly Diana Konczak | Dietitian, Registered | 4011 Talbot Rd S, Suite 100, Renton, WA 98055-5773 | 2017-02-09 |
| 1578931325 | Andrew S Huntley | Physician Assistant | 4011 Talbot Rd S, Suite 300, Renton, WA 98055-5773 | 2015-09-10 |
| 1285011080 | Anne Macleod | Registered Nurse | 4011 Talbot Rd S, Renton, WA 98055-5773 | 2015-04-30 |
| 1508263716 | Mie Hagiwara | Physician Assistant | 4011 Talbot Rd S, Suite 300, Renton, WA 98055-5773 | 2014-12-03 |
| 1073921813 | Zachary A. Bowman | Physician Assistant | 4011 Talbot Rd S, Suite 300, Renton, WA 98055-5773 | 2014-07-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356965750 | Proliance Surgery Center At Valley, LLC | Clinic/Center | 4009 Talbot Road S, Suite 200, Renton, WA 98055 | 2020-06-01 |
| 1851804959 | Talbot Rehabilitation Center, LLC | Skilled Nursing Facility | 4430 Talbot Road South, Renton, WA 98055 | 2017-11-10 |
| 1154878668 | Nelson Family Dentistry | Dentist | 19221 108th Ave Se Suite #2, Renton, WA 98055 | 2016-09-01 |
| 1598182990 | Annie Kyunga Ahn | Otolaryngology | 4033 Talbot Rd S Ste 540, Renton, WA 98055 | 2014-03-24 |
| 1376960138 | Madhuri Gordhan Patel | Registered Nurse | 3501 Mill Place South, Renton, WA 98055 | 2014-03-18 |
| 1912331042 | Karen Dohr | Pharmacist | 400 S. 43 Street, Renton, WA 98055 | 2013-08-26 |
| 1659637668 | Benjamin Reiss | Ophthalmology | 4300 Talbot Rd S Ste 300, Renton, WA 98055 | 2012-04-03 |
| 1205137940 | Duy Ai Quang Hoang | Pharmacist | 9431 S 196th Pl, Renton, WA 98055 | 2010-11-11 |
| 1972823664 | Erica L Ellzey | Physical Therapist | 18623 112th Ave Se, Renton, WA 98055 | 2010-06-04 |
| 1588984587 | Melissa A. Jordan | Nurse Anesthetist, Certified Registered | 4011 Talbot Rd., 5th Floor, Renton, WA 98055 | 2010-06-02 |
| Find all providers in zip 98055 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619410891 | Carlin Doyle | Physician Assistant | 4011 Talbot Rd S Ste 300, Renton, WA 98055 | 2016-11-21 |
| 1376794792 | David Russell Gifford | Physician Assistant | 4011 Talbot Rd S, Suite 300, Renton, WA 98055-5773 | 2008-10-03 |
| 1023149630 | Chad Carson Moloney | Physician Assistant | 4011 Talbot Rd S, Suite 300, Renton, WA 98055-5773 | 2007-03-07 |
| 1811040504 | Mark L Bowers | Physician Assistant | 4011 Talbot Rd S, Suite 300, Renton, WA 98055-5773 | 2007-01-18 |
| 1922197565 | Jordan James Patrick Vieira | Physician Assistant | 4011 Talbot Rd S, Suite 300, Renton, WA 98055-5773 | 2006-10-12 |
| 1013940170 | Allison J Warmington | Physician Assistant | 4033 Talbot Rd S, Suite 530, Renton, WA 98055-5772 | 2006-07-09 |
| 1831125178 | Wendy R Nyland | Physician Assistant | 4011 Talbot Rd S, Suite 300, Renton, WA 98055-5773 | 2006-06-25 |
| 1376588673 | Jana L Flener | Physician Assistant | 4011 Talbot Rd S, Suite 300, Renton, WA 98055-5773 | 2006-06-19 |
| 1821039488 | Public Hospital District #1 of King County | Physician Assistant | 3915 Talbot Rd S, Suite 216, Renton, WA 98055-5738 | 2006-06-08 |
| 1285633255 | Gregory K Parker | Physician Assistant | 4011 Talbot Rd S, Suite 300, Renton, WA 98055-5773 | 2005-07-20 |
| Find all providers in RENTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.