MEDICARE: ANA GABRIELA GONZALEZ RD,LD

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	133V00000X	Registered Dietitian	DT84268	TX

General Provider Information

NPI Number	:	1750051959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA GABRIELA GONZALEZ RD,LD

Provider Business Mailing Address
First Line	:	214 N 16TH ST STE 125
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78501-7984
Country	:	US
Telephone Number	:	956-655-8007
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 N 16TH ST STE 125
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78501-7984
Country	:	US
Telephone Number	:	956-655-8007
Fax Number	:

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

Provider Enumeration Date	:	09/18/2021
Last Update Date	:	09/18/2021

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