Provider Demographics
NPI:1730360066
Name:GONZALEZ, MIA DELAGARZA (PA -C)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:DELAGARZA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PA -C
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Mailing Address - Street 1:3100 BUDDY OWENS AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6464
Mailing Address - Country:US
Mailing Address - Phone:956-971-0404
Mailing Address - Fax:956-971-0408
Practice Address - Street 1:2764 PHARMACY RD
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-6201
Practice Address - Country:US
Practice Address - Phone:956-317-1601
Practice Address - Fax:956-317-1603
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2016-04-08
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Provider Licenses
StateLicense IDTaxonomies
TXPA04897363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant