Provider Demographics
NPI:1912489303
Name:GONZALEZ, YOLANDA ELENA (PA)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:ELENA
Last Name:GONZALEZ
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 1:600 N GARZA ST
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-3538
Mailing Address - Country:US
Mailing Address - Phone:956-487-0846
Mailing Address - Fax:956-487-0855
Practice Address - Street 1:600 N GARZA ST
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-3538
Practice Address - Country:US
Practice Address - Phone:956-487-0846
Practice Address - Fax:956-487-0855
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12058363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX391401201Medicaid