Provider Demographics
NPI:1063530681
Name:GONZALEZ, LINDA PUIG (PA)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:PUIG
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 1:5505 N MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2208
Mailing Address - Country:US
Mailing Address - Phone:956-683-8100
Mailing Address - Fax:956-683-8153
Practice Address - Street 1:5505 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2208
Practice Address - Country:US
Practice Address - Phone:956-683-8100
Practice Address - Fax:956-683-8153
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04893363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX308844501Medicaid
TX40147949OtherDPS REGISTRATION #
TX308844501Medicaid