Provider Demographics
NPI:1376733865
Name:GONZALES, CHRISTINA ISABEL (OPA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ISABEL
Last Name:GONZALES
Suffix:
Gender:F
Credentials:OPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6624 FANNIN ST
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2312
Mailing Address - Country:US
Mailing Address - Phone:713-790-1818
Mailing Address - Fax:713-790-7500
Practice Address - Street 1:6624 FANNIN ST
Practice Address - Street 2:SUITE 2600
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2312
Practice Address - Country:US
Practice Address - Phone:713-790-1818
Practice Address - Fax:713-790-7500
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX760363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX760OtherOPA-C CERTIFICATION #