Healthcare Provider Details

I. General information

NPI: 1669026704
Provider Name (Legal Business Name): CHRISTINE M GONZALES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 04/01/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S. BROADWAY
ELSA TX
78543
US

IV. Provider business mailing address

307 N D SALINAS BLVD
DONNA TX
78537
US

V. Phone/Fax

Practice location:
  • Phone: 956-262-1304
  • Fax: 956-262-1304
Mailing address:
  • Phone: 956-464-2402
  • Fax: 956-464-3339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP142535
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL3631
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP142535
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: