Healthcare Provider Details

I. General information

NPI: 1003222787
Provider Name (Legal Business Name): CHRISTIAN GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 PEASE ST
HARLINGEN TX
78550-8307
US

IV. Provider business mailing address

PO BOX 534358
HARLINGEN TX
78553-4358
US

V. Phone/Fax

Practice location:
  • Phone: 956-421-2414
  • Fax:
Mailing address:
  • Phone: 956-421-2414
  • Fax: 956-421-3321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR2858
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: