MEDICARE: GONZALAZ MED SUPPLIES LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1013873686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GONZALAZ MED SUPPLIES LLC

Provider Business Mailing Address
First Line	:	11133 SHADY TRL
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-4617
Country	:	US
Telephone Number	:	224-224-5125
Fax Number	:

Provider Business Practice Location Address
First Line	:	11133 SHADY TRL
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-4617
Country	:	US
Telephone Number	:	224-224-5125
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	AMANDA J JOHNSON
Credential	:
Telephone Number	:	22-422-4551

Provider Enumeration Date	:	12/29/2025
Last Update Date	:	12/29/2025

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