MEDICARE: OLIVIA GONZALES

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1811141062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA GONZALES

Provider Business Mailing Address
First Line	:	2300 W COMMERCE ST
Second Line	:	SUITE 300
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-3839
Country	:	US
Telephone Number	:	210-922-0103
Fax Number	:	210-922-0162

Provider Business Practice Location Address
First Line	:	204 NOLAN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78202-2153
Country	:	US
Telephone Number	:	210-229-9322
Fax Number	:	210-227-5239

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

Provider Enumeration Date	:	11/13/2008
Last Update Date	:	11/13/2008

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Directions to “ OLIVIA GONZALES ” Practice Location

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