MEDICARE: LESLIE A GONZALEZ

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	225X00000X	Occupational Therapist	114183	TX

General Provider Information

NPI Number	:	1023306222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE A GONZALEZ

Provider Business Mailing Address
First Line	:	349 S HELEN MOORE RD APT 8205
Second Line	:
City	:	SAN BENITO
State	:	TX
Zip	:	78586-9093
Country	:	US
Telephone Number	:	956-607-8329
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 HIGHWAY 100 STE 9
Second Line	:
City	:	PORT ISABEL
State	:	TX
Zip	:	78578-2450
Country	:	US
Telephone Number	:	956-607-8329
Fax Number	:

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

Provider Enumeration Date	:	07/21/2011
Last Update Date	:	06/23/2023

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Directions to “ LESLIE A GONZALEZ ” Practice Location

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