MEDICARE: MS. MELINDA GONZALEZ P.A.-C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA05740	TX

General Provider Information

NPI Number	:	1760651186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELINDA GONZALEZ P.A.-C.

Provider Business Mailing Address
First Line	:	8711 VILLAGE DR STE 114
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5419
Country	:	US
Telephone Number	:	210-297-2244
Fax Number	:	210-297-2257

Provider Business Practice Location Address
First Line	:	540 MADISON OAK DR STE 570
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3933
Country	:	US
Telephone Number	:	210-402-3700
Fax Number	:	210-402-3892

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/29/2008
Last Update Date	:	03/17/2018

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