Healthcare Provider Details

I. General information

NPI: 1184015265
Provider Name (Legal Business Name): SAMANTHA GONZALES LM/CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 720099
NORMAN OK
73070-4077
US

IV. Provider business mailing address

PO BOX 720099
NORMAN OK
73070-4077
US

V. Phone/Fax

Practice location:
  • Phone: 512-299-0139
  • Fax: 844-444-0696
Mailing address:
  • Phone: 512-299-0139
  • Fax: 844-444-0696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: