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Individual

MRS. CHRISTINE M GONZALES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
3624 OAK LAWN AVE STE 110B, DALLAS, TX 75219-4711
(214) 892-2271
(361) 200-4261
Mailing address
3624 OAK LAWN AVE STE 110B, DALLAS, TX 75219-4711
(214) 892-2271
(361) 200-4261

Taxonomy

Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
PA08075
TX
363A00000X
Physician Assistant
PA5504
MA
363AM0700X
Medical Physician Assistant
Primary
PA08075
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
320119960
TAX ID
TX
Enumeration date
11/15/2012
Last updated
10/09/2022
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