Provider Demographics
NPI:1194929703
Name:GONZALES, DIANIRA C (SLP)
Entity type:Individual
Prefix:MS
First Name:DIANIRA
Middle Name:C
Last Name:GONZALES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 W. HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-5012
Mailing Address - Country:US
Mailing Address - Phone:956-631-9171
Mailing Address - Fax:956-631-7566
Practice Address - Street 1:1217 W. HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5012
Practice Address - Country:US
Practice Address - Phone:956-631-9171
Practice Address - Fax:956-631-7566
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18126235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1875825-03Medicaid