Provider Demographics
NPI:1376655316
Name:GONZALES, MIGDALIA LOPEZ (FNP)
Entity type:Individual
Prefix:
First Name:MIGDALIA
Middle Name:LOPEZ
Last Name:GONZALES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MIGDALIA
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1400 N IH 35
Mailing Address - Street 2:STE. 2.230
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1926
Mailing Address - Country:US
Mailing Address - Phone:512-324-8235
Mailing Address - Fax:512-324-8223
Practice Address - Street 1:1400 N IH 35
Practice Address - Street 2:STE. 2.230
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1926
Practice Address - Country:US
Practice Address - Phone:512-324-8235
Practice Address - Fax:512-324-8223
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX447873363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX209970703Medicaid
TX209970704Medicaid
TX299932YL9XMedicare PIN
TX209970704Medicaid