Provider Demographics
NPI:1942314323
Name:ALONSO, GLORIA MUNOZ (PA)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:MUNOZ
Last Name:ALONSO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 CASTROVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-5147
Mailing Address - Country:US
Mailing Address - Phone:210-434-1400
Mailing Address - Fax:210-337-2909
Practice Address - Street 1:448 CASTROVILLE RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5147
Practice Address - Country:US
Practice Address - Phone:210-434-1400
Practice Address - Fax:210-337-2909
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02091363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218294101Medicaid
TX2182941-02Medicaid
TX92001OtherCARELINK
TX8N7246OtherBCBS
TX443266YLPSOtherWELLMED PTAN
TXTXB113490Medicare PIN
TX2182941-02Medicaid