Healthcare Provider Details

I. General information

NPI: 1629763560
Provider Name (Legal Business Name): NILMAR PAOLA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HIGHLANDER POINT DR STE 300
FLOYDS KNOBS IN
47119-9465
US

IV. Provider business mailing address

14023 SOUTHWEST FWY
SUGAR LAND TX
77478-3550
US

V. Phone/Fax

Practice location:
  • Phone: 812-923-2273
  • Fax: 812-923-4100
Mailing address:
  • Phone: 281-325-4100
  • Fax: 281-325-4292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01100470A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: