Healthcare Provider Details

I. General information

NPI: 1083047112
Provider Name (Legal Business Name): ROSE A GONZALEZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 06/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 HOLCOMBE BLVD
HOUSTON TX
77030-4211
US

IV. Provider business mailing address

2002 HOLCOMBE BLVD
HOUSTON TX
77030-4211
US

V. Phone/Fax

Practice location:
  • Phone: 713-794-1414
  • Fax:
Mailing address:
  • Phone: 713-794-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number37065
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: