Provider Demographics
NPI:1760651186
Name:GONZALEZ, MELINDA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8711 VILLAGE DR STE 114
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5419
Mailing Address - Country:US
Mailing Address - Phone:210-297-2244
Mailing Address - Fax:210-297-2257
Practice Address - Street 1:540 MADISON OAK DR STE 570
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3933
Practice Address - Country:US
Practice Address - Phone:210-402-3700
Practice Address - Fax:210-402-3892
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA05740363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical