Provider Demographics
NPI:1700055829
Name:GONZALES, CHRISTINA GRANADO (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:GRANADO
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:DANIELLE
Other - Last Name:GRANADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5219 CITY BANK PKWY STE 35
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3545
Mailing Address - Country:US
Mailing Address - Phone:806-761-0333
Mailing Address - Fax:806-722-2908
Practice Address - Street 1:2703 82ND ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1429
Practice Address - Country:US
Practice Address - Phone:806-761-0428
Practice Address - Fax:806-712-0168
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05660363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant