Provider Demographics
NPI:1063730828
Name:GONZALEZ, DINA (NP)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 MAIN STREET
Mailing Address - Street 2:SUITE 5200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-7365
Mailing Address - Country:US
Mailing Address - Phone:214-712-2448
Mailing Address - Fax:
Practice Address - Street 1:1717 MAIN STREET
Practice Address - Street 2:SUITE 5200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-7365
Practice Address - Country:US
Practice Address - Phone:214-712-2448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX735336207P00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine