Provider Demographics
NPI:1760768584
Name:GONZALEZ MORIN, JOHANNA ALEXANDRA (PA-C)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:ALEXANDRA
Last Name:GONZALEZ MORIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3006 LAS COLINAS LN
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-1927
Mailing Address - Country:US
Mailing Address - Phone:954-478-8971
Mailing Address - Fax:
Practice Address - Street 1:2821 MICHAELANGELO DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1404
Practice Address - Country:US
Practice Address - Phone:956-632-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08271363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical