MEDICARE: ARNOLDO ARTURO GONZALEZ JR. ATC, LAT

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	2255A2300X	Athletic Trainer	AT6227	TX

General Provider Information

NPI Number	:	1063047363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARNOLDO ARTURO GONZALEZ JR. ATC, LAT

Provider Business Mailing Address
First Line	:	1033 TRUEMBER ST
Second Line	:
City	:	LACKLAND AFB
State	:	TX
Zip	:	78236
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1033 TRUEMPER ST
Second Line	:
City	:	LACKLAND AFB
State	:	TX
Zip	:	78236
Country	:	US
Telephone Number	:	210-445-2068
Fax Number	:

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

Provider Enumeration Date	:	03/06/2020
Last Update Date	:	03/06/2020

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