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NPI Code Detail

MEDICARE: ALYSSA GONZALEZ

MEDICARE: ALYSSA 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
1106S00000XBehavior TechnicianRBT21181414TX
2390200000XStudent in an Organized Health Care Education/Training ProgramTX
3363A00000XPhysician AssistantPA19966TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RBT-21-181414OTHERTXBACB

General Provider Information

NPI Number : 1881360410
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSSA GONZALEZ
Provider Business Mailing Address
First Line : 5323 HARRY HINES BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75390-9090
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6201 HARRY HINES BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75235-5202
Country : US
Telephone Number : 214-645-8898
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2021
Last Update Date : 04/15/2026

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Directions to “ ALYSSA GONZALEZ ” Practice Location

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