MEDICARE: MS. JEAN W GONZALEZ CPO

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	222Z00000X	Orthotist	1155	TX
2	224P00000X	Prosthetist	1155	TX

General Provider Information

NPI Number	:	1578637518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEAN W GONZALEZ CPO

Provider Business Mailing Address
First Line	:	10818 ALY TRACE CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-3128
Country	:	US
Telephone Number	:	832-604-6321
Fax Number	:

Provider Business Practice Location Address
First Line	:	12926 WILLOW CHASE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-5641
Country	:	US
Telephone Number	:	281-897-1108
Fax Number	:

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	09/11/2025

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