Healthcare Provider Details

I. General information

NPI: 1477045219
Provider Name (Legal Business Name): ADAM CLEMENTE GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 ALBERTA AVE
EL PASO TX
79905-2727
US

IV. Provider business mailing address

4505 ALBERTA AVE
EL PASO TX
79905-2727
US

V. Phone/Fax

Practice location:
  • Phone: 915-532-1447
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberBP10063421
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberT4926
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: