Provider Demographics
NPI:1306115464
Name:GONZALES, ANGELICA (PA-C)
Entity type:Individual
Prefix:MS
First Name:ANGELICA
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:
Other - Last Name:CARRASCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4304 ANDREWS HWY
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4824
Mailing Address - Country:US
Mailing Address - Phone:432-520-3020
Mailing Address - Fax:432-699-1981
Practice Address - Street 1:4304 ANDREWS HWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-4824
Practice Address - Country:US
Practice Address - Phone:432-520-3020
Practice Address - Fax:432-699-1981
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8586NHOtherBCBS
TX339245801Medicaid
TX8586NHOtherBCBS