Individual
DIANA C GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
250 BAILEY RANCH RD STE 300, ALEDO, TX 76008-3237
(682) 593-3237
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(866) 370-8206
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1219777
TX
225100000X
Physical Therapist
3111710
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0031DG
BLUE CROSS BLUE SHIELD
TX
05
—
0944746-02
—
TX
Enumeration date
06/08/2012
Last updated
05/22/2024
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