Healthcare Provider Details

I. General information

NPI: 1851272645
Provider Name (Legal Business Name): SANDY GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19140 CROSBY EASTGATE RD
CROSBY TX
77532-3954
US

IV. Provider business mailing address

19140 CROSBY EASTGATE RD
CROSBY TX
77532-3954
US

V. Phone/Fax

Practice location:
  • Phone: 346-677-2391
  • Fax:
Mailing address:
  • Phone: 346-677-2391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1218755
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: