MEDICARE: LUIS C 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	343900000X	Non-emergency Medical Transport (VAN)		TX

General Provider Information

NPI Number	:	1023815602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS C GONZALEZ

Provider Business Mailing Address
First Line	:	10342 GLIMMER
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109-0800
Country	:	US
Telephone Number	:	508-274-5151
Fax Number	:

Provider Business Practice Location Address
First Line	:	10342 GLIMMER
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109-0800
Country	:	US
Telephone Number	:	508-274-5151
Fax Number	:

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

Provider Enumeration Date	:	02/28/2025
Last Update Date	:	03/05/2025

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Directions to “ LUIS C GONZALEZ ” Practice Location

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