Provider Demographics
NPI:1073198438
Name:GONZALEZ, EMILY SOCORRO (PA-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:SOCORRO
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 1:119 ELKINGTON LOOP
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8170
Mailing Address - Country:US
Mailing Address - Phone:956-220-8739
Mailing Address - Fax:
Practice Address - Street 1:908 ROCKMOOR DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-8966
Practice Address - Country:US
Practice Address - Phone:512-868-0901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant