Provider Demographics
NPI:1437048782
Name:GONZALEZ, LIDUINA PAOLA (SA-C)
Entity type:Individual
Prefix:
First Name:LIDUINA
Middle Name:PAOLA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 BAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-6705
Mailing Address - Country:US
Mailing Address - Phone:469-473-6011
Mailing Address - Fax:
Practice Address - Street 1:6800 HERITAGE PKWY STE 108
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-8746
Practice Address - Country:US
Practice Address - Phone:972-463-1811
Practice Address - Fax:833-592-2353
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25-105246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant