Provider Demographics
NPI:1063205516
Name:GONZALEZ, LEAH MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:GONZALEZ
Suffix:
Gender:F
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 1:62 E 1200 N
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-1238
Mailing Address - Country:US
Mailing Address - Phone:385-482-4161
Mailing Address - Fax:
Practice Address - Street 1:10290 N NORTH COUNTY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-6012
Practice Address - Country:US
Practice Address - Phone:801-899-3391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14225430-1206207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine