Basic Information
| Provider Information | |||||||||
| NPI: | 1841231446 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | VIRGINIA | ||||||||
| MiddleName: | YOLANDA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2595 DALLAS PKWY | ||||||||
| Address2: | SUITE 405 | ||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750348527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723771490 | ||||||||
| FaxNumber: | 9723771499 | ||||||||
| Practice Location | |||||||||
| Address1: | 18780 INTERSTATE 20 | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751033593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035674841 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A070362 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | M4997 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 587504YMAF | 01 | TX | MEDICARE | OTHER | 204267302 | 01 | TX | MEDICAID OTHER | OTHER | 8HB435 | 01 | TX | BCBS | OTHER | 204267303 | 05 | TX | MEDICAID | 75-2616977-001 | 01 | TX | TRICARE | OTHER | P01878880 | 01 | TX | MEDICARE RAIL ROAD | OTHER |